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General NPI Number Information
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NPI Number | 1912134685
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Entity Type | Individual
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Provider Name | DR. KYLE JEFFERY
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Gender | Male
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 945 W HOSPITAL DR STE 4
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City | PRICE
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State | UT
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Zip | 84501-4230
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Country | US
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Telephone | 435-613-7874
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Fax | 435-637-1808
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Provider Business Mailing Address
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Address Line | 925 E MCDOWELL RD 2ND FLOOR
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City | PHOENIX
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State | AZ
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Zip | 85006-2502
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Country | US
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Telephone | 602-239-2282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 368163-1205
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License Number State | UT
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