Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1034600501 | UT |
NPI | 1144267089 |
---|---|
Provider Name | Gary R Ridge |
First Address | Orem, UT 84057-1909 |
Second Address | Orem, UT 84057-1909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0761150001 | CIGNA MEDICARE (01) | UT |
107006243102 | SELECT HEALTH (01) | UT |
19925 | DESERET MUTUAL (01) | UT |
2365 | PUBLIC EMPLOYEES HEALTH (01) | UT |
270510 | ALTIUS HEALTH PLANS (01) | UT |
E0110 | (05) | UT |
T77938 | (02) | UT |