Individual
CODY NEBEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
970 MEDICAL DR STE 202, BRIGHAM CITY, UT 84302-3286
(435) 695-2273
Mailing address
2950 N CHURCH ST STE 301, LAYTON, UT 84040-6590
(801) 771-7771
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301105892
MI
208600000X
Surgery Physician
Primary
6034453-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301105892
MEIDCAL LICENSE
MI
01
—
5315066446
CONTROLLED SUBSTANCE
MI
Enumeration date
06/19/2014
Last updated
08/12/2022
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