Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 5960240-1205 | UT |
NPI | 1205942059 |
---|---|
Provider Name | Dr. Christian Scott Millward |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | St George, UT 84790-7017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 11/08/2011 |