Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4752590-1205 | UT |
N | 207PE0004X | Emergency Medical Services | 4752590-1205 | UT |
NPI | 1023087343 |
---|---|
Provider Name | Deanne Long |
First Address | Salt Lake City, UT 84108-1250 |
Second Address | Salt Lake City, UT 84108-1250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 15/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10552 | HEALTHY U (01) | UT |
243586 | ALTIUS (01) | UT |
47525901202001 | BC/BS (01) | UT |
608789600 | W/C (01) | UT |
D3567 | (05) | UT |
H22967 | (02) | UT |
P00396754 | RAILROAD MEDICARE (01) | UT |