Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 2613601205 | UT |
NPI | 1104839208 |
---|---|
Provider Name | Leslie Mark Lang |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Provo, UT 84604-3380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |