Doctor Name: | CARL KENT HEBDON |
NPI Number: | 1215971759 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D., M.S. |
License Number: | 160845-8905 |
Business Practice Address: | 2040 Murray Holladay Rd Suite 209 Salt Lake City, UT - 841175185 |
Business Phone Number: | 8012730306 |
Business Fax Number: | 8015471929 |
Mailing Address: | 2040 Murray Holladay Rd, Suite 209 SALT LAKE CITY |
State: | UT |
Postal Code: | 841175185 |
Phone Number: | 8012730306 |
Fax Number: | 8015471929 |
NPI Enumeration Date: | 06/15/2006 |
NPI Last Update Date: | 01/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 160845-8905 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |