Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 9786 | MT |
Y | 207VX0000X | Obstetrician | Q6223 | TX |
NPI | 1255378212 |
---|---|
Provider Name | John David Laraway |
First Address | Spanish Fork, UT 84660-2060 |
Second Address | Spanish Fork, UT 84660-1396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255378212 | (05) | ID |
1255378212 | (05) | MT |
1255378212 | (05) | WA |
G89766 | (02) |