Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 841716741205 | UT |
N | 208800000X | Urologist | 841716741205 | UT |
Y | 2088P0231X | Pediatric Urologist | 171674-1205 | UT |
NPI | 1275544454 |
---|---|
Provider Name | Dr. Brent Walter Snow |
First Address | Salt Lake City, UT 84141-3035 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 28/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3048900 | (05) | ID |
C63637 | (02) |