Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2693081205 | UT |
NPI | 1003836636 |
---|---|
Provider Name | Dr. Joseph J Albano |
First Address | Salt Lake City, UT 84171-0547 |
Second Address | Salt Lake City, UT 84121-6923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 29/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F72985 | (02) | UT |