Basic Information
| Provider Information | |||||||||
| NPI: | 1356755110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEBEKER | ||||||||
| FirstName: | CODY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2950 N CHURCH ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840406590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017717771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 970 MEDICAL DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | BRIGHAM CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843023286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356952273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301105892 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 6034453-1205 | UT | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5315066446 | 01 | MI | CONTROLLED SUBSTANCE | OTHER | 4301105892 | 01 | MI | MEIDCAL LICENSE | OTHER |