Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 172807-1205 | UT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 172807-1205 | UT |
NPI | 1578522959 |
---|---|
Provider Name | Randal W Swenson |
First Address | Slc, UT 84107-2180 |
Second Address | Slc, UT 84107-2180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
870354540001 | (05) | UT |
A52174 | (02) | UT |