Provider Demographics
NPI:1871516641
Name:MINTZ, STEVEN J (DR)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:MINTZ
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 S 1100 E
Mailing Address - Street 2:#201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-478-0010
Mailing Address - Fax:801-363-1847
Practice Address - Street 1:24 S 1100 E
Practice Address - Street 2:#201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1500
Practice Address - Country:US
Practice Address - Phone:801-478-0010
Practice Address - Fax:801-363-1847
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1612601205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC19444Medicare UPIN