| NPI | 1578550083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD TINGEY Board President 801-475-3481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 207N00000X Dermatology | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 208600000X Surgery | |
| 208800000X Urology | |
| 208C00000X Colon & Rectal Surgery | |
| 213E00000X Podiatrist | |
| 225100000X Physical Therapist | |
| 231H00000X Audiologist | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2021-02-03 |