Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 3186281205 | UT |
NPI | 1093757965 |
---|---|
Provider Name | Dr. Bruce Bennett Reid |
First Address | Salt Lake City, UT 84103-2853 |
Second Address | Salt Lake City, UT 84103-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
942854059169 | (05) | UT |
H34513 | (02) | UT |