Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 168731-1205 | UT |
N | 208200000X | Surgeon | 168731-1205 | UT |
N | 208600000X | Surgeon | 168731-1205 | UT |
N | 2086S0120X | Pediatric Surgery | 168731-1205 | UT |
N | 2086S0127X | Trauma Surgeon | 168731-1205 | UT |
NPI | 1255432001 |
---|---|
Provider Name | Dr. John Taylor Smith |
First Address | Salt Lake City, UT 84141-3026 |
Second Address | Slc, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 23/11/2021 |