Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 5114957-1205 | UT |
Y | 207RP1001X | Pulmonary Disease | 5114957-1205 | UT |
N | 207RS0012X | Sleep Medicine | 5114957-1205 | UT |
NPI | 1013994813 |
---|---|
Provider Name | Ali Ahmed Fazili |
First Address | Salt Lake City, UT 84103-2858 |
Second Address | Salt Lake City, UT 84103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 11/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46708 | (02) |