Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 11055189-1205 | UT |
NPI | 1124598198 |
---|---|
Provider Name | Dr. Loren Kyle Gulbranson |
First Address | Gatineau, QC 921 |
Second Address | Saint George, UT 84770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2018 |
Last Update Date | 03/12/2018 |