Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 3477061205 | UT |
N | 207ND0101X | MOHS-Micrographic Surgeon | 3477061205 | UT |
Y | 207NS0135X | Procedural Dermatology | 3477061205 | UT |
NPI | 1508076928 |
---|---|
Provider Name | Paul E. Harrison |
First Address | Sandy, UT 84070-4156 |
Second Address | Sandy, UT 84070-4156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 10/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G05956 | (02) | UT |