Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 10361256-1204 | UT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101015940 | MI |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OP 60077459 | WA |
NPI | 1649460163 |
---|---|
Provider Name | Dr. Ryan W Leonard |
First Address | Salt Lake City, UT 84120-5530 |
Second Address | West Jordan, UT 84088-5610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0250118 | LABOR & INDUSTRIES (01) | WA |
1649460163 | (05) | WA |