Individual
DR. SHANNON L TILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1525 W 2100 S, SALT LAKE CITY, UT 84119-1401
(801) 213-9900
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
54125001205
UT
Other
Enumeration date
05/17/2006
Last updated
08/10/2021
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