Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 260693-2401 | UT |
NPI | 1184735755 |
---|---|
Provider Name | Kirk D Kingery |
First Address | Provo, UT 84604-3305 |
Second Address | Provo, UT 84604-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/04/2008 |