Provider Demographics
NPI:1801857271
Name:ENT PROFESSIONAL ASSOCIATION SERVICES
Entity Type:Organization
Organization Name:ENT PROFESSIONAL ASSOCIATION SERVICES
Other - Org Name:ENT SPECIALISTS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SONKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-4141
Mailing Address - Street 1:4000 S 700 E
Mailing Address - Street 2:STE 10
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2180
Mailing Address - Country:US
Mailing Address - Phone:801-268-4141
Mailing Address - Fax:801-261-8609
Practice Address - Street 1:4000 S 700 E
Practice Address - Street 2:STE 10
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84107-2180
Practice Address - Country:US
Practice Address - Phone:801-268-4141
Practice Address - Fax:801-261-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5239207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty