Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 10255195-1205 | UT |
N | 208000000X | Pediatrician | 47602 | AZ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 10255195-1205 | UT |
N | 2080P0204X | Pediatric Emergency Doctor | 10255195-1205 | UT |
NPI | 1225340003 |
---|---|
Provider Name | Dr. Dustin Edward Monroe |
First Address | Orem, UT 84057-3660 |
Second Address | Orem, UT 84057-3660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 10/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
825752 | (05) | AZ |
MD47602 | LICENSE (01) | AZ |