Organization
BEAR RIVER UROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E VAN BIBBER MD (OWNER)
(801) 821-6717
Entity
Organization
Contact information
Practice address
196 ARROWHEAD DR, SUITE #4, EVANSTON, WY 82930-8752
(307) 789-8721
Mailing address
196 ARROWHEAD DR, SUITE #4, EVANSTON, WY 82930-8752
(307) 789-8721
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
TL#1572
WY
Other
Enumeration date
06/23/2011
Last updated
06/23/2011
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