Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 1778771205 | UT |
NPI | 1023094992 |
---|---|
Provider Name | Robert L Mellor |
First Address | Layton, UT 84041 |
Second Address | Layton, UT 84041-8803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09119 | (05) | UT |
A97309 | (02) |