Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5328713-9922 | UT |
NPI | 1124111323 |
---|---|
Provider Name | Dr. Mitchell G Rudd |
First Address | Salt Lake City, UT 84105-3684 |
Second Address | Salt Lake City, UT 84105-3684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 19/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01595375 | UNITED CONCORDIA NUMBER (01) | UT |