Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 7259622-0504 | UT |
N | 213ES0131X | Foot Surgery | N004009 | NY |
NPI | 1053560789 |
---|---|
Provider Name | Dr. Susan Jespersen Agres |
First Address | Ogden, UT 84403-0902 |
Second Address | Ogden, UT 84405-6748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 30/07/2015 |