Organization
GORDON R. KIMBALL M.D.,P.C.
Active
Other names
Lone Peak Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARMA H MORGAN (OFFICE MANAGER)
(801) 571-7061
Entity
Organization
Contact information
Practice address
9844 S 1300 E, SUITE 275, SANDY, UT 84094-4673
(801) 571-7061
(801) 572-4564
Mailing address
9844 S 1300 E, SUITE 275, SANDY, UT 84094-4673
(801) 571-7061
(801) 572-4564
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0551110013
UT
363AS0400X
Surgical Physician Assistant
1093777047
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578545919
INDIVIDUAL NPI
UT
05
—
999000116008
—
UT
Enumeration date
09/17/2009
Last updated
07/13/2010
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