Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 12366058-0501 | UT |
NPI | 1194387571 |
---|---|
Provider Name | Nathaniel A Ptak |
First Address | Murray, UT 84107-5701 |
Second Address | Murray, UT 84107-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 20/07/2021 |