Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 9348982-1205 | UT |
NPI | 1134355225 |
---|---|
Provider Name | Dr. Phillip Lee Chaffin JR. |
First Address | Provo, UT 84604-3306 |
Second Address | Provo, UT 84604-3306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 13/07/2015 |