Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 5068619-1205 | UT |
NPI | 1003172495 |
---|---|
Provider Name | Kendell Ryan Klingler |
First Address | Murray, UT 84107-7704 |
Second Address | Murray, UT 84107-7704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 17/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003172495 | (05) | UT |
U000094229 | (02) | UT |