Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 1153249 | UT |
NPI | 1164909479 |
---|---|
Provider Name | Mr. Tanner Lee Frey |
First Address | Lindon, UT 84042-1302 |
Second Address | Provo, UT 84604-3380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 13/07/2019 |