Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 58953691205 | UT |
Y | 207QS0010X | Family Doctor - Sports Medicine | 58953691205 | UT |
NPI | 1609845775 |
---|---|
Provider Name | Dr. Spencer E. Richards |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Bountiful, UT 84010-6136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
942854058788-D6150 | (05) | UT |
I31070 | (02) | UT |