Provider Demographics
NPI:1457312845
Name:HIBBARD, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 N 1075 W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2745
Mailing Address - Country:US
Mailing Address - Phone:801-451-4538
Mailing Address - Fax:801-451-2295
Practice Address - Street 1:1401 N 1075 W
Practice Address - Street 2:SUITE 220
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2745
Practice Address - Country:US
Practice Address - Phone:801-451-4538
Practice Address - Fax:801-451-2295
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT4983982-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH84222Medicare UPIN
UT005804801Medicare ID - Type Unspecified