Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 11751221-1205 | UT |
NPI | 1053845339 |
---|---|
Provider Name | Dr. Matthew David Beaver |
First Address | Salt Lake City, UT 84113-1125 |
Second Address | Salt Lake City, UT 84113-1125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 05/06/2020 |