Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 173734-1205 | UT |
NPI | 1013028901 |
---|---|
Provider Name | Dale Mark Valentine |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Sandy, UT 84094-3763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 07/12/2015 |