Most Relevant Information
Provider Data
| NPI Number: | 1003181173 |
| Provider Name: | GARY WAYNE MATRAVERS MD |
| Entity Type: | Individual |
| Taxonomy Code: | 2083X0100X |
| Specialty: | Preventive Medicine |
| License Number: | 169591-1205 |
Most Important Dates
| Enumeration Date: | 03/21/2012 |
| Last Updated: | 03/21/2012 |
Provider Practice Location
11600 STARK RD
STOCKTON
UT
840719712
Practice Location Phone/Fax
| Phone: | 4358337796 |
| Fax: | 4358337667 |
Provider Mailing Location
11600 STARK RD
STOCKTON
UT
840719712
Provider Mailing Phone/Fax
| Phone: | 4358337796 |
| Fax: | 4358337667 |