Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 12512523-1205 | UT |
NPI | 1821761263 |
---|---|
Provider Name | Sarup S. Sridharan |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2021 |
Last Update Date | 14/10/2021 |