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Shane Park
NPI 1265850143 · on the registry since 2014 · sole proprietor
Practice
- Address
- 5500 W Bagley Park Rd
West Jordan, UT 84081 - Phone
- (702) 917-4192
- Organisation at this address
- Havenwood Ii
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 14
Registry record
- Primary taxonomy
- 103K00000X
103K00000X
- Sex
- Male
- Record last updated
- 2014-03-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah