Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 12208312-1205 | UT |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 12208312-1205 | UT |
NPI | 1265967442 |
---|---|
Provider Name | Adebayo A. Adesomo |
First Address | Salt Lake City, UT 84132-2209 |
Second Address | Salt Lake City, UT 84132-2209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 16/10/2021 |