Individual
KIMBALL LAEL CHRISTIANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N 500 W, SUITE 112, BLDG. C, PROVO, UT 84604
(801) 812-4624
(801) 812-4699
Mailing address
1055 N 500 W, ATTN. CREDENTIALING, PROVO, UT 84604-4649
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10926114-1205
UT
2085R0202X
Diagnostic Radiology Physician
2010-00277
NC
2085R0202X
Diagnostic Radiology Physician
M-11249
ID
2085R0202X
Diagnostic Radiology Physician
MD153988
OR
390200000X
Student in an Organized Health Care Education/Training Program
135137
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306895016
—
ID
Enumeration date
05/01/2008
Last updated
12/08/2023
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