Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | B00981 | NV |
Y | 213ER0200X | Radiology | B00981 | NV |
NPI | 1104988989 |
---|---|
Provider Name | Dr. Thor Patrick Mongie |
First Address | Payson, UT 84651-2239 |
Second Address | Payson, UT 84651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 02/08/2018 |