Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 7969819-1205 | UT |
NPI | 1033390877 |
---|---|
Provider Name | Marielle Payne Young |
First Address | Salt Lake City, UT 84141-3075 |
Second Address | Salt Lake City, UT 84132-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 29/11/2021 |