Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 48597921205 | UT |
NPI | 1225119019 |
---|---|
Provider Name | Dr. Earl Courtney Downey JR. |
First Address | Salt Lake City, UT 84103-1962 |
Second Address | Salt Lake City, UT 84103-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 29/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01076184B. | PHYSICIAN LICENSE (01) | IN |
D3887 | (05) | UT |
G45941 | PHYSICIAN LICENSE (01) | CA |
TD151161 | PHYSICIAN LICENSE (01) | ME |