Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 11926746-0501 | UT |
NPI | 1003346545 |
---|---|
Provider Name | Dr. Clay Bryant Shumway |
First Address | West Jordan, UT 84084-2020 |
Second Address | West Jordan, UT 84088-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 24/06/2021 |