Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 7730185-7100 | UT |
NPI | 1134422538 |
---|---|
Provider Name | Dr. Brevan B Baugh |
First Address | Providence, UT 84332-4801 |
Second Address | Providence, UT 84332-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2010 |
Last Update Date | 13/10/2014 |