Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 6273962-1205 | UT |
Y | 208600000X | Surgeon | 6273962-1205 | UT |
N | 2086X0206X | Surgical Oncologist | 6273962-1205 | UT |
NPI | 1215042288 |
---|---|
Provider Name | Dr. Robert H Andtbacka |
First Address | Salt Lake City, UT 84158-0681 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 12/02/2015 |