Provider Demographics
NPI:1467412973
Name:HEBREW, J. LINKE (MD)
Entity Type:Individual
Prefix:
First Name:J. LINKE
Middle Name:
Last Name:HEBREW
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 1:144 S 500 E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-964-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175253-1205207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD1231Medicaid
UT005568307Medicare ID - Type Unspecified3460 PIONEER PKWY, WVC
UT005567113Medicare ID - Type Unspecified1600 ANTELOPE DR, LAYTON
UTD1231Medicaid
UTE31830Medicare UPIN
UT005567213Medicare ID - Type Unspecified5475 S 500 E, OGDEN
UT005568506Medicare ID - Type Unspecified630 MEDICAL DR, BOUNTIFUL