Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | UT |
NPI | 1205913035 |
---|---|
Provider Name | Dr. F. Zane Jessen |
First Address | Ogden, UT 84405-4889 |
Second Address | Ogden, UT 84405-4889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48825 | (02) | UT |