Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A11500 | CA |
N | 208000000X | Pediatrician | 20A11500 | CA |
N | 208000000X | Pediatrician | H1137 | TX |
NPI | 1184890063 |
---|---|
Provider Name | Gregg Cary Lund |
First Address | Salt Lake City, UT 84108-1222 |
Second Address | Salt Lake City, UT 84108-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 19/07/2019 |