Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 7771259-1205 | UT |
N | 2084N0400X | Neurologist | 7771259-1205 | UT |
NPI | 1346483617 |
---|---|
Provider Name | Peter M. Hannon |
First Address | Salt Lake City, UT 84141-3027 |
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 | 15/04/2009 |
Last Update Date | 02/11/2021 |