Individual
DR. PAVALAN PANNEER SELVAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
295 S CHIPETA WAY RM 2W245, SALT LAKE CITY, UT 84108-1287
(801) 581-2121
Mailing address
295 S CHIPETA WAY RM 2W245, SALT LAKE CITY, UT 84108-1287
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
13521401-1205
UT
208000000X
Pediatrics Physician
13521401-1205
UT
Other
Enumeration date
03/28/2022
Last updated
08/03/2023
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