Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 8790910-1205 | UT |
NPI | 1003176934 |
---|---|
Provider Name | Dr. Aaron Michael Secrest |
First Address | Salt Lake City, UT 84132 |
Second Address | Farmington, UT 84025-2990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 18/11/2021 |