Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 6942268-1205 | UT |
N | 207QA0401X | Family Doctor - Addiction Medicine | 6942268-1205 | UT |
NPI | 1306065636 |
---|---|
Provider Name | Nick Carl Greenwood |
First Address | Salt Lake City, UT 84110-1710 |
Second Address | Salt Lake City, UT 84101-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 13/08/2012 |