Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 176560-1205 | UT |
NPI | 1841278942 |
---|---|
Provider Name | Dr. Daniel Shane Sellers |
First Address | Bountiful, UT 84010-5176 |
Second Address | Bountiful, UT 84010-4908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D20205 | (02) | UT |