Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 104906-0501 | UT |
N | 213ES0131X | Foot Surgery | 104906-0501 | UT |
NPI | 1154337046 |
---|---|
Provider Name | Dr. Gregg K Young |
First Address | Salt Lake City, UT 84148-0001 |
Second Address | Salt Lake City, UT 84148-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U27288 | (02) | UT |