Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4854725-4405 | UT |
NPI | 1003121799 |
---|---|
Provider Name | Mr. Timothy S Garvey |
First Address | Salt Lake City, UT 84113-1103 |
Second Address | Riverton, UT 84065-7215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 18/08/2010 |