Provider Demographics
NPI:1275647562
Name:HIBBERT, DANIEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:HIBBERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11179 S IVY CREEK CV
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2249
Mailing Address - Country:US
Mailing Address - Phone:801-822-2727
Mailing Address - Fax:435-882-0073
Practice Address - Street 1:2376 N 400 E STE 104
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3413
Practice Address - Country:US
Practice Address - Phone:435-882-0071
Practice Address - Fax:435-882-0073
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT7100427-1205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology