Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 180827-1205 | UT |
NPI | 1215918297 |
---|---|
Provider Name | Gregory G Patch |
First Address | Salt Lake City, UT 84125-0488 |
Second Address | Farmington, UT 84025-2746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 26/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107007749104 | SELECTHEALTH (01) | UT |
266077 | DESERET MUTUAL BENEFITS ADMINISTRATORS (01) | UT |
300064158 | RAILROAD MEDICARE (01) | UT |
B63906 | (02) | |
D0957 | (05) | UT |