Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 11250304-1205 | UT |
Y | 208600000X | Surgeon | 11250304-1205 | UT |
N | 208200000X | Surgeon | 201098 | NC |
N | 208600000X | Surgeon | 201098 | NC |
NPI | 1013335280 |
---|---|
Provider Name | Paul Tenzel |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 12/06/2019 |