Provider Demographics
NPI:1457562233
Name:STEEVES, STACEY WADE (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:WADE
Last Name:STEEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S. WADE
Other - Middle Name:
Other - Last Name:STEEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:370 E 9TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3182
Mailing Address - Country:US
Mailing Address - Phone:801-331-9660
Mailing Address - Fax:
Practice Address - Street 1:370 E 9TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3182
Practice Address - Country:US
Practice Address - Phone:801-331-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601400352084N0400X
390200000X
UT14191822-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808632600Medicaid
WA1457562233Medicaid