Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 322409-1204 | UT |
NPI | 1760677520 |
---|---|
Provider Name | Ronald Baird |
First Address | West Jordan, UT 84084-4007 |
Second Address | West Jordan, UT 84084-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G61949 | (02) | UT |