Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 1771311205 | UT |
NPI | 1174617336 |
---|---|
Provider Name | Steven Charles Simper |
First Address | Salt Lake City, UT 84124 |
Second Address | Salt Lake City, UT 84124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F54231 | (02) |