Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 8926321-0501 | UT |
NPI | 1023390531 |
---|---|
Provider Name | Robert A Church |
First Address | Bountiful, UT 84010-4801 |
Second Address | Bountiful, UT 84010-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2011 |
Last Update Date | 27/09/2016 |