Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 9779327-1205 | UT |
N | 111NI0900X | Internist | 9779327-1205 | UT |
N | 207RH0000X | Hematologist | 9779327-1205 | UT |
N | 207RH0003X | Hematology & Oncology | 9779327-1205 | UT |
Y | 207RX0202X | Medical Oncology | 9779327-1205 | UT |
NPI | 1144663493 |
---|---|
Provider Name | Dr. Robert Allan Havard III |
First Address | Salt Lake City, UT 84124-1297 |
Second Address | Salt Lake City, UT 84106-1494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 04/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9779327-1205 | UT STATE LICENSE (01) | UT |