Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | G8313 | CA |
NPI | 1003958828 |
---|---|
Provider Name | Gail A. Magid |
First Address | Salt Lake City, UT 84111-2002 |
Second Address | Salt Lake City, UT 84111-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A58347 | (02) | CA |