Individual
JACOB TROY GIBBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3152 N UNIVERSITY AVE STE 100, PROVO, UT 84604-4746
(801) 229-2002
Mailing address
3152 N UNIVERSITY AVE STE 100, PROVO, UT 84604-4746
(801) 229-2002
Taxonomy
Speciality
Code
Description
License number
State
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
13494110-1205
UT
2085N0700X
Neuroradiology Physician
Primary
13494110-1205
UT
2085R0202X
Diagnostic Radiology Physician
13494110-1205
UT
Other
Enumeration date
03/25/2019
Last updated
07/24/2025
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