Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 12229855-1205 | UT |
N | 207ND0101X | MOHS-Micrographic Surgeon | 12229855-1205 | UT |
NPI | 1003344862 |
---|---|
Provider Name | Dr. Alyson Anne Thede |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 17/12/2021 |