Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11265776-1205 | UT |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 11265776-1205 | UT |
NPI | 1205254042 |
---|---|
Provider Name | Matthew Craig |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2014 |
Last Update Date | 10/06/2019 |