Individual
KELLY W HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2245 N 400 E STE 104, NORTH LOGAN, UT 84341-1785
(435) 753-1600
(435) 753-9521
Mailing address
560 W 465 N STE 604, PROVIDENCE, UT 84332-8006
(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
3085198-1205
UT
207NS0135X
Procedural Dermatology Physician
3085198-1205
UT
Other
Enumeration date
05/10/2006
Last updated
07/18/2023
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