Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 9857371-1204 | UT |
NPI | 1053631069 |
---|---|
Provider Name | Tye B Harrison |
First Address | Woods Cross, UT 84087-2361 |
Second Address | Brigham City, UT 84302-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 02/08/2021 |