Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 30830841205 | UT |
NPI | 1003872433 |
---|---|
Provider Name | Ryan Nelson Jones |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | American Fork, UT 84003-2022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H17917 | (02) | UT |