Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 6162283-9921 | UT |
NPI | 1023268299 |
---|---|
Provider Name | Jared Reed Brown |
First Address | Heber City, UT 84032-2240 |
Second Address | Heber City, UT 84032-2240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 25/08/2015 |