Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2869891205 | UT |
N | 207XS0106X | Orthopaedic Hand Surgeon | D0064980 | MD |
NPI | 1164564860 |
---|---|
Provider Name | Dirk L Slade |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | St George, UT 84790-7049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 06/07/2012 |