Provider Demographics
NPI:1225131279
Name:BYBEE, BLAIR LAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:LAMAR
Last Name:BYBEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 1300 E
Mailing Address - Street 2:#301
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1756
Mailing Address - Country:US
Mailing Address - Phone:801-323-9755
Mailing Address - Fax:
Practice Address - Street 1:44 N MEDIAL DRIVE
Practice Address - Street 2:UTAH DEPARTMENT OF HEALTH
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84114-4630
Practice Address - Country:US
Practice Address - Phone:801-584-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT153119-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics