Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 182809-1205 | UT |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 182809-1205 | UT |
NPI | 1023199825 |
---|---|
Provider Name | Dr. Charles Olin Canfield |
First Address | Sandy, UT 84070-9391 |
Second Address | South Jordan, UT 84095-3915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 04/01/2021 |