Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | C18364 | UT |
N | 222Z00000X | Podiatrist | C18364 | UT |
Y | 224P00000X | Prosthetist | C18364 | UT |
N | 224P00000X | Prosthetist | CP003176 | UT |
NPI | 1063663474 |
---|---|
Provider Name | Michael Scott Miner |
First Address | Salt Lake City, UT 84148-0001 |
Second Address | Salt Lake City, UT 84148-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2008 |
Last Update Date | 24/11/2008 |