Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 19500 | MT |
Y | 2084N0402X | Child Neurologist | 186741-1205 | UT |
NPI | 1225117898 |
---|---|
Provider Name | Colin B. Van Orman |
First Address | Salt Lake City, UT 84141-3021 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 20/12/2021 |