Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 202784 | LA |
Y | 207T00000X | Neurosurgeon | 44123 | MN |
N | 207T00000X | Neurosurgeon | 91820 | OH |
NPI | 1073585477 |
---|---|
Provider Name | Philip Andrew Utter |
First Address | Shreveport, LA 71101 |
Second Address | Shreveport, LA 71101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200821100 | (05) | MN |
H50692 | (02) | |
H50962 | (02) |