Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 11899046-1205 | UT |
NPI | 1033679840 |
---|---|
Provider Name | Sean M. Collon |
First Address | Salt Lake City, UT 84132-0005 |
Second Address | Salt Lake City, UT 84132-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2019 |
Last Update Date | 21/08/2020 |