Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 6884270-1205 | UT |
NPI | 1013926393 |
---|---|
Provider Name | Robert W Grow |
First Address | Salt Lake City, UT 84102-1907 |
Second Address | Ogden, UT 84405-6905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 01/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
886605000 | (05) | MN |
I58606 | (02) | MN |