Organization
KELLY W HUBBARD MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY KARTSONE (ACCOUNTS MANAGER)
(435) 753-1600
Entity
Organization
Contact information
Practice address
2380 N 400 E, STE B, LOGAN, UT 84341-1749
(435) 752-5741
Mailing address
274 N MAIN ST, LOGAN, UT 84321-3915
(435) 753-1600
(435) 753-9521
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
3085198-1205
UT
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
3085198-1205
UT
207NP0225X
Pediatric Dermatology Physician
3085198-1208
UT
207NS0135X
Procedural Dermatology Physician
3085198-1205
UT
Other
Enumeration date
09/20/2007
Last updated
11/08/2007
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