Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 11624821-8904 | UT |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2012034290 | MO |
N | 207Q00000X | Family Doctor | CERTIFICATE 8677 | MI |
NPI | 1225141641 |
---|---|
Provider Name | Jay Brian Danto |
First Address | Vineyard, UT 84059-6631 |
Second Address | Provo, UT 84604-7407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G75950 | (02) |