Provider Demographics
NPI:1124598198
Name:GULBRANSON, LOREN KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:KYLE
Last Name:GULBRANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:KYLE
Other - Middle Name:LOREN
Other - Last Name:GULBRANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:51 AVE DES JONQUILES
Mailing Address - Street 2:
Mailing Address - City:GATINEAU
Mailing Address - State:QC
Mailing Address - Zip Code:921
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DIXIE REGIONAL MEDICAL CENTER
Practice Address - Street 2:515 SOUTH, 300 EAST
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11055189-1205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine