Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 10403324-8906 | UT |
NPI | 1053838532 |
---|---|
Provider Name | John Evan Thomas |
First Address | Bountiful, UT 84010-2853 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 20/12/2021 |