Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 27181 | OK |
Y | 207Q00000X | Family Doctor | 8252545-1205 | UT |
NPI | 1003041740 |
---|---|
Provider Name | Dr. Casey Joseph Henich |
First Address | West Valley City, UT 84120-5530 |
Second Address | West Valley City, UT 84120-5530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 13/05/2013 |