Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 11163441-1205 | UT |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 11163441-1205 | UT |
NPI | 1205254885 |
---|---|
Provider Name | Derek Vanhille |
First Address | Provo, UT 84604-3522 |
Second Address | Payson, UT 84651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 11/02/2020 |