Gordon R. Kimball M.D.,P.C.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

0551110013 Issued in UT

Legal business name

GORDON R. KIMBALL M.D.,P.C.

Doing business as

Lone Peak Orthopedics

Practice address

9844 S 1300 E
Suite 275
Sandy, UT 84094-4673

Phone

(801) 571-7061

Fax

(801) 572-4564

NPI assigned

Sep 17, 2009

Last updated

Jul 13, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carma H Morgan

Title

Office Manager

Phone

(801) 571-7061

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Lone Peak Orthopedics Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1316270655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9844 S 1300 E",
            "address_2": "SUITE 275",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840944673",
            "telephone_number": "801-571-7061",
            "fax_number": "801-572-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9844 S 1300 E",
            "address_2": "SUITE 275",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840944673",
            "telephone_number": "801-571-7061",
            "fax_number": "801-572-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON R. KIMBALL M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-17",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "CARMA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-571-7061",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "1093777047",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "UT",
            "license": "0551110013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1578545919",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999000116008",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Peak Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthopaedic Surgery Physician in Sandy, UT
• Providers in Sandy, UT by specialty
• Orthopaedic Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.