Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 3208681205 | UT |
NPI | 1467486795 |
---|---|
Provider Name | Dr. Nathan G Momberger |
First Address | Murray, UT 84107-6121 |
Second Address | Murray, UT 84107-6121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H22841 | (02) | UT |