Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 3099134-1205 | UT |
NPI | 1073557583 |
---|---|
Provider Name | Nathan B Eliason |
First Address | Murray, UT 84123-5671 |
Second Address | Murray, UT 84123-5671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H02809 | (02) | WY |
PENDING | (05) | UT |