Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1154414498 |
---|---|
Provider Name | Paul W Brinkerhoff |
First Address | Roosevelt, UT 84066-3106 |
Second Address | Roosevelt, UT 84066-3106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2006 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870536042008 | (05) | UT |
87053604202001 | BXBS (01) | UT |