Healthcare Provider Details

I. General information

NPI: 1487182705
Provider Name (Legal Business Name): LINDA SUSAN IQBAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 S 900 E STE 240
MURRAY UT
84117-7210
US

IV. Provider business mailing address

4845 S BRON BRECK ST
HOLLADAY UT
84117-6414
US

V. Phone/Fax

Practice location:
  • Phone: 801-428-3389
  • Fax:
Mailing address:
  • Phone: 484-620-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10348672-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: