Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4932664-1205 | UT |
NPI | 1013187525 |
---|---|
Provider Name | Dr. Kyle Andrews Gardner |
First Address | Salt Lake City, UT 84130-0180 |
Second Address | Murray, UT 84107-5705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2008 |
Last Update Date | 27/06/2019 |