Provider Demographics
NPI:1770880130
Name:GUBLER, KYLE EVAN (MMSC, PA-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:EVAN
Last Name:GUBLER
Suffix:
Gender:M
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:30 N 1900 E, SUITE 3C127
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-209-2632
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH CARDIOTHORACIC SURGERY
Practice Address - Street 2:30 N 1900 E, SUITE 3C127
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-3626
Practice Address - Country:US
Practice Address - Phone:801-585-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7898193-1206363A00000X, 363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant