Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 9368064-1205 | UT |
NPI | 1306032347 |
---|---|
Provider Name | Jonathan Skirko |
First Address | Salt Lake City, UT 84130-0180 |
Second Address | Seattle, WA 98195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2007 |
Last Update Date | 15/02/2016 |