Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2704071205 | UT |
Y | 207Q00000X | Family Doctor | 942704071205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 972704071205 | UT |
NPI | 1477562767 |
---|---|
Provider Name | Ronald Mark Firth |
First Address | Logan, UT 84321 |
Second Address | Logan, UT 84321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 27/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000063977 | (02) | UT |
F97784 | (02) | UT |