Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 3624831205 | UT |
NPI | 1609818616 |
---|---|
Provider Name | Jon B Bishop |
First Address | Orem, UT 84057-6301 |
Second Address | Orem, UT 84057-6301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 16/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F21970 | (02) | UT |