Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 1565291205 | UT |
NPI | 1033126271 |
---|---|
Provider Name | Mr. Lee Jeppson Malan |
First Address | Ogden, UT 84403 |
Second Address | Ogden, UT 84403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D07265 | (02) |