Provider Demographics
NPI:1871539833
Name:GLEDHILL, KENT M (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:M
Last Name:GLEDHILL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:1055 N 500 W
Practice Address - Street 2:SUITE 112
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-812-4624
Practice Address - Fax:801-812-4699
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT338798-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00157756OtherPALMETTO GBA
UT219637OtherALTIUS
UT311124OtherDMBA
UT870281028KETOtherEMIA
UT107001825102OtherIHC
UT79255OtherPEHP
UT16-00689OtherUNITED HEALTHCARE
UT311124OtherDMBA
UTF79996Medicare UPIN
UT005502559Medicare ID - Type UnspecifiedMEDICARE