Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 7414873-0501 | UT |
NPI | 1023256120 |
---|---|
Provider Name | Dr. Jeremy Strange |
First Address | Vernal, UT 84078-2010 |
Second Address | Vernal, UT 84078-2049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 05/06/2017 |