Provider Demographics
NPI:1124084587
Name:HUARD, G STEDMAN II (MD)
Entity type:Individual
Prefix:DR
First Name:G
Middle Name:STEDMAN
Last Name:HUARD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:#310
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4488
Mailing Address - Country:US
Mailing Address - Phone:435-688-1922
Mailing Address - Fax:435-688-1901
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:#310
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-688-1922
Practice Address - Fax:435-688-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341095-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTA89841Medicare UPIN
UT000011946Medicare ID - Type Unspecified