Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 102832-0501 | UT |
NPI | 1043213168 |
---|---|
Provider Name | Scott Martin Soulier |
First Address | Salt Lake City, UT 84117-4243 |
Second Address | Salt Lake City, UT 84117-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48826 | (02) | UT |