Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 51817281205 | UT |
NPI | 1083629828 |
---|---|
Provider Name | James Thomas Dane |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Provo, UT 84604-3344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 15/06/2010 |