Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 174662-1205 | UT |
NPI | 1134149610 |
---|---|
Provider Name | Eric V Smart |
First Address | Salt Lake City, UT 84130-0180 |
Second Address | Murray, UT 84107-6548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 29/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B07391 | (02) | UT |