Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 5371038-1204 | UT |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 537110371204 | UT |
NPI | 1063481646 |
---|---|
Provider Name | Dr. Michael P Eyre |
First Address | Spanish Fork, UT 84660-1232 |
Second Address | Spanish Fork, UT 84660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I01143 | (02) |