Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 376019-1205 | UT |
NPI | 1083704688 |
---|---|
Provider Name | Paul Andrew House |
First Address | Murray, UT 84107-5713 |
Second Address | Murray, UT 84107-5713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 22/01/2020 |