Organization
PACIFIC COLON AND RECTAL CLINIC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES G HIBBERT MD (OWNER)
(425) 899-4600
Entity
Organization
Contact information
Practice address
12303 NE 130TH LN, SUITE 530, KIRKLAND, WA 98034-3099
(425) 899-4600
Mailing address
12303 NE 130TH LN, SUITE 530, KIRKLAND, WA 98034-3099
(425) 899-4600
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
MD00030958
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49129
L & I STATE
WA
05
—
7054836
—
WA
01
—
PA9248
REGENCE
WA
Enumeration date
12/07/2007
Last updated
05/27/2011
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