Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | 89-180960-1205 | UT |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 89-180960-1205 | UT |
NPI | 1912023383 |
---|---|
Provider Name | Dr. Leland Russel Chick |
First Address | Salt Lake City, UT 84102-1500 |
Second Address | Salt Lake City, UT 84124-1383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A65293 | (02) | UT |