Individual
DR. KENNETH PAUL LIBRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10160 E HIGHWAY 210, SUITE 1, GOLDMINER'S DAUGHTER LODGE, ALTA, UT 84092-8072
(801) 742-2273
Mailing address
PO BOX 8072, ALTA, UT 84092-8072
(801) 742-2273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
328690-1205
UT
Other
Enumeration date
12/23/2005
Last updated
12/21/2012
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