Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 9679367-1205 | UT |
N | 208600000X | Surgeon | 9679367-1205 | UT |
Y | 208200000X | Surgeon | M-11722 | ID |
Y | 208600000X | Surgeon | M-11722 | ID |
NPI | 1013134550 |
---|---|
Provider Name | Gregg Arthur Marshall |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Logan, UT 84341-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 14/09/2021 |