Provider Demographics
NPI:1669416129
Name:HILLYARD, JOHN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:HILLYARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1899 E MYSTIC GROVE CV
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84093-5509
Mailing Address - Country:US
Mailing Address - Phone:801-935-1983
Mailing Address - Fax:385-255-9888
Practice Address - Street 1:1899 E MYSTIC GROVE CV
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84093-5509
Practice Address - Country:US
Practice Address - Phone:801-935-1983
Practice Address - Fax:385-255-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT168816-1205207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039507101Medicaid
TX039507101Medicaid
TX81J933Medicare ID - Type Unspecified