Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | E0619 | TX |
NPI | 1295755924 |
---|---|
Provider Name | Gary D Snook |
First Address | Tooele, UT 84074-8138 |
Second Address | Tooele, UT 84074-3440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B26544 | (02) | UT |