Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 7112893-1204 | UT |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 71112893-1204 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 71112893-1204 | UT |
NPI | 1063492304 |
---|---|
Provider Name | Dr. Gary L Child |
First Address | Lehi, UT 84043-9771 |
Second Address | Lehi, UT 84043-9771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 14/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063492304 | (05) | UT |