Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 5166746-1205 | UT |
NPI | 1053325365 |
---|---|
Provider Name | Jodie Karen Levitt |
First Address | Salt Lake City, UT 84105-3760 |
Second Address | Salt Lake City, UT 84105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 12/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G34747 | (02) | UT |