Provider Demographics
NPI:1275415309
Name:BOU FADEL, CHRISTY (MD (MBBS))
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:
Last Name:BOU FADEL
Suffix:
Gender:F
Credentials:MD (MBBS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STANSBURY HEALTH CENTER (TOOEIE)
Mailing Address - Street 2:220 MILLPOND ROAD, 100
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074
Mailing Address - Country:US
Mailing Address - Phone:435-843-3000
Mailing Address - Fax:
Practice Address - Street 1:STANSBURY HEALTH CENTER (TOOEIE)
Practice Address - Street 2:220 MILLPOND ROAD, 100
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-843-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14211096-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine