Individual
WENDELL ANDREW GIBBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3152 N UNIVERSITY AVE DEPT OF, PROVO, UT 84604-4745
(801) 229-2002
(202) 877-3288
Mailing address
3152 N UNIVERSITY AVE, PROVO, UT 84604-4745
(801) 229-2002
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
9875187-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/16/2013
Last updated
07/10/2019
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