Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 158955-1205 | UT |
N | 207VX0000X | Obstetrician | 1589551205 | UT |
NPI | 1316986714 |
---|---|
Provider Name | Dr. Brian L Wolsey |
First Address | Provo, UT 84601-1548 |
Second Address | Provo, UT 84601-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 17/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D07831 | (02) |