Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 8262639-1204 | UT |
NPI | 1154553469 |
---|---|
Provider Name | Luke Devon Maese |
First Address | Salt Lake City, UT 84102-1971 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 18/11/2021 |