Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 3496681205 | UT |
N | 207ND0101X | MOHS-Micrographic Surgeon | 3496681205 | UT |
N | 207NS0135X | Procedural Dermatology | 3496681205 | UT |
NPI | 1407943921 |
---|---|
Provider Name | Dr. Payam Tristani-Firouzi |
First Address | Provo, UT 84604-3305 |
Second Address | Provo, UT 84604-3305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 20/12/2021 |