Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 58244501205 | UT |
NPI | 1003863770 |
---|---|
Provider Name | Adam R Krommenhoek |
First Address | Spanish Fork, UT 84660-0010 |
Second Address | Provo, UT 84604-3380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 21/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002330031 | (02) | |
58244501200001 | BCBS (01) | |
D6138 | (05) | UT |
I24937 | (02) | |
P00249192 | RAILROAD MEDICARE (01) |