Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 9005425-1205 | UT |
Y | 2086X0206X | Surgical Oncologist | 9005425-1205 | UT |
NPI | 1376764282 |
---|---|
Provider Name | Joan D Miles |
First Address | Murray, UT 84107-5701 |
Second Address | Murray, UT 84107-8410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0294913 | L&I (01) | WA |
1376764282 | (05) | WA |