Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 54160868905 | UT |
NPI | 1932307188 |
---|---|
Provider Name | Lucy Jane Barr |
First Address | Salt Lake City, UT 84102-1686 |
Second Address | Salt Lake City, UT 84102-1686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 03/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000064118 | MEDICARE PTAN (01) | UT |
1932367976 | (05) | UT |