Individual
DR. KYLE BLAKE FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-8310
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
14203517-1205
UT
207R00000X
Internal Medicine Physician
A189549
CA
208M00000X
Hospitalist Physician
Primary
14203517-1205
UT
Other
Enumeration date
04/05/2022
Last updated
01/08/2026
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