Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD00048675 | WA |
N | 207T00000X | Neurosurgeon | MD00048675 | WA |
Y | 208000000X | Pediatrician | 9097278-1205 | UT |
NPI | 1609193622 |
---|---|
Provider Name | Hunter Reeve Underhill |
First Address | Salt Lake City, UT 84102-1971 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1609193622 | (05) | WA |