Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 7320335-1202 | UT |
NPI | 1295002640 |
---|---|
Provider Name | Dr. Cody Clayton Mecham |
First Address | Salt Lake City, UT 84109-3022 |
Second Address | Salt Lake City, UT 84109-3022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 29/11/2011 |