MEDICARE: CARL KENT HEBDON MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	160845-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124114038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL KENT HEBDON MD PC

Provider Business Mailing Address
First Line	:	PO BOX 1797
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-6797
Country	:	US
Telephone Number	:	801-547-1991
Fax Number	:	801-547-1929

Provider Business Practice Location Address
First Line	:	2040 MURRAY HOLLADAY RD
Second Line	:	SUITE 209
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5185
Country	:	US
Telephone Number	:	801-273-0306
Fax Number	:	801-273-0317

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	CARL KENT HEBDON
Credential	:	MD
Telephone Number	:	801-547-1991

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/17/2008

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