Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 9763983-1205 | UT |
NPI | 1982141008 |
---|---|
Provider Name | Douglas Kehl |
First Address | Washington, UT 84780-8524 |
Second Address | Washington, UT 84780-8524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2017 |
Last Update Date | 26/01/2017 |