Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 169555-1205 | UT |
NPI | 1023298882 |
---|---|
Provider Name | Harold Vonk |
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 | 09/11/2007 |
Last Update Date | 24/06/2016 |