Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 5804089 | UT |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 5804089-1205 | UT |
NPI | 1003808122 |
---|---|
Provider Name | Khaldoun M Al-Rayess |
First Address | Layton, UT 84041-0337 |
Second Address | Layton, UT 84041-8803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000G57660 | GROUP (01) | |
005766004 | (02) | |
I32923 | (02) | UT |