MEDICARE: DR. BLAIR LAMAR BYBEE M.D.

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	208000000X	Pediatrics Physician	153119-1205	UT

General Provider Information

NPI Number	:	1225131279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR LAMAR BYBEE M.D.

Provider Business Mailing Address
First Line	:	130 S 1300 E
Second Line	:	#301
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1756
Country	:	US
Telephone Number	:	801-323-9755
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 N MEDIAL DRIVE
Second Line	:	UTAH DEPARTMENT OF HEALTH
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84114-4630
Country	:	US
Telephone Number	:	801-584-8246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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