Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 105077-0501 | UT |
Y | 222Z00000X | Podiatrist | 105077-0501 | UT |
N | 213EP1101X | Primary Podiatric Medicine | 105077-0501 | UT |
N | 2081S0010X | Sports Medicine | 105077--0501 | UT |
N | 213ES0000X | Sports Medicine | 105077--0501 | UT |
N | 213ES0103X | Foot & Ankle Surgery | 105077-0501 | UT |
NPI | 1154437655 |
---|---|
Provider Name | David Jaramillo |
First Address | Provo, UT 84604-6620 |
Second Address | Provo, UT 84604-6620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 18/04/2008 |