Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7711982-1205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301088182 | MI |
NPI | 1083824940 |
---|---|
Provider Name | Dr. Mina Gohari |
First Address | Atlanta, GA 30374-2382 |
Second Address | Salt Lake City, UT 84124-1202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000057838 | PTAN (01) | UT |