Provider Demographics
NPI:1124061155
Name:ROPER, STEPHEN G (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:ROPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:#5000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1275
Mailing Address - Country:US
Mailing Address - Phone:801-262-8486
Mailing Address - Fax:801-262-9752
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:#5000
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1275
Practice Address - Country:US
Practice Address - Phone:801-262-8486
Practice Address - Fax:801-262-9752
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51877361206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00054599OtherRAILROAD MEDICARE
UT1054555OtherNCCPA
UTMR0869226OtherDEA
UTP00054599OtherRAILROAD MEDICARE