Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 11313930-0501 | UT |
Y | 222Z00000X | Podiatrist | 11313930-0501 | UT |
NPI | 1053801324 |
---|---|
Provider Name | Jordan James Radandt |
First Address | Riverton, UT 84096-7405 |
Second Address | Salt Lake City, UT 84106-3095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2018 |
Last Update Date | 14/09/2021 |