Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 11414375-1205 | UT |
Y | 208600000X | Surgeon | 11414375-1205 | UT |
NPI | 1003311614 |
---|---|
Provider Name | Alexandria Tran |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 17/09/2019 |