Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 11379080-1205 | UT |
NPI | 1003307539 |
---|---|
Provider Name | Zachary Jon Ahola |
First Address | Ogden, UT 84403-3295 |
Second Address | Ogden, UT 84403-3295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2018 |
Last Update Date | 16/08/2019 |