Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 60083151205 | UT |
Y | 207RP1001X | Pulmonary Disease | 60083151205 | UT |
N | 207RS0012X | Sleep Medicine | 60083151205 | UT |
NPI | 1104875574 |
---|---|
Provider Name | Tala'at Al-Shuqairat |
First Address | Provo, UT 84604-3305 |
Second Address | Salem, UT 84653-1666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000059100 | MEDICARE (01) | UT |
870281028000 | (05) | UT |
I55215 | (02) | UT |