Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 345070-1205 | UT |
NPI | 1104916709 |
---|---|
Provider Name | Martha Jane Glenn |
First Address | Salt Lake City, UT 84141-3033 |
Second Address | Salt Lake City, UT 84112-5500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 12/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01008562 | RAILROAD MEDICARE (01) | UT |