Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03568 | |
N | 222Z00000X | Podiatrist | CPO03568 | |
Y | 224P00000X | Prosthetist | CPO03568 | |
N | 225000000X | Orthotic Fitter |
NPI | 1720655459 |
---|---|
Provider Name | Benjamin Josh Carlson |
First Address | Provo, UT 84604-3373 |
Second Address | Layton, UT 84041-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 15/06/2021 |