| NPI | 1053844753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JOLLEY Dpm 435-462-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 9141980-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 9141980-0501) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-04-18 |