Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 8591638-1204 | UT |
Y | 207QS0010X | Family Doctor - Sports Medicine | 8591638-1204 | UT |
N | 208D00000X | General Practice Physician | 5101018672 | MI |
NPI | 1124339460 |
---|---|
Provider Name | Cory Nelson |
First Address | Lehi, UT 84043-7498 |
Second Address | Lehi, UT 84043-7498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 08/09/2021 |