Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 7365628-1205 | UT |
NPI | 1205871043 |
---|---|
Provider Name | Dr. Shiro Fujita |
First Address | Murray, UT 84107-5704 |
Second Address | Murray, UT 84107-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 28/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H20706 | (02) |