Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2015-02260 | NC |
N | 208600000X | Surgeon | 2015-02260 | NC |
Y | 208200000X | Surgeon | 9743925-1204 | UT |
Y | 208600000X | Surgeon | 9743925-1204 | UT |
NPI | 1013145697 |
---|---|
Provider Name | Mario Damon La Giglia |
First Address | Blanding, UT 84511-3910 |
Second Address | Blanding, UT 84511-3910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 03/04/2019 |