NPIMap

Organization Active NPI

Gavin Van Staden MD PC

  • Clinic/Center
  • Bountiful, UT
National Provider Identifier
1801174172
Registry record updated Aug 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5863514-1205 Issued in UT
Legal business name
GAVIN VAN STADEN MD PC
Practice address
3263 S Highway 89
Ste 300
Bountiful, UT 84010-8555
Phone
(801) 296-0600
NPI assigned
Aug 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gavin Van Staden, MD
Title
Dr
Phone
(801) 201-2771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 5863514-1205 UT Primary

Addresses

Primary practice location

3263 S Highway 89
Ste 300
Bountiful, UT 84010-8555

Mailing address

3263 S Highway 89
Ste 300
Bountiful, UT 84010-8555

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1801174172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3263 S HIGHWAY 89",
            "address_2": "STE 300",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3263 S HIGHWAY 89",
            "address_2": "STE 300",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108555",
            "telephone_number": "801-296-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAVIN VAN STADEN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-03",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "VAN STADEN",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "801-201-2771",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": "5863514-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.