Organization
CANYON CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH P LIBRE MD (MEDICAL DIRECTOR)
(801) 742-9820
Entity
Organization
Contact information
Practice address
10160 E STATE HIGHWAY 210 STE 2, ALTA, UT 84092-9509
(801) 742-9820
Mailing address
PO BOX 8072, ALTA, UT 84092-8072
(801) 742-2273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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