Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 151257-1205 | UT |
NPI | 1023014297 |
---|---|
Provider Name | Dennis D. Thoen |
First Address | Salt Lake City, UT 84124-1216 |
Second Address | Salt Lake City, UT 84124-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 14/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04164 | (05) | UT |
D07718 | (02) |