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General NPI Number Information
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NPI Number | 1124114038
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Entity Type | Organization
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Legal Business Name | CARL KENT HEBDON MD PC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 2040 MURRAY HOLLADAY RD SUITE 209
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-5185
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Country | US
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Telephone | 801-273-0306
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Fax | 801-273-0317
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Provider Business Mailing Address
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Address Line | PO BOX 1797
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City | LAYTON
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State | UT
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Zip | 84041-6797
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Country | US
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Telephone | 801-547-1991
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Fax | 801-547-1929
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CARL KENT HEBDON
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Credential | MD
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Telephone | 801-547-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 160845-1205
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License Number State | UT
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