1124598198 NPI number — DR. LOREN KYLE GULBRANSON MD

Table of content: DR. LOREN KYLE GULBRANSON MD (NPI 1124598198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124598198 NPI number — DR. LOREN KYLE GULBRANSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULBRANSON
Provider First Name:
LOREN
Provider Middle Name:
KYLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GULBRANSON
Provider Other First Name:
KYLE
Provider Other Middle Name:
LOREN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124598198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 AVE DES JONQUILES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GATINEAU
Provider Business Mailing Address State Name:
QC
Provider Business Mailing Address Postal Code:
921
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DIXIE REGIONAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
515 SOUTH, 300 EAST
Provider Business Practice Location Address City Name:
SAINT GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-251-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  11055189-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)