Organization
UROLOGIC SURGERY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN HIBBERT MD (MANAGER)
(801) 822-2727
Entity
Organization
Contact information
Practice address
11179 IVY CREEK CV, SOUTH JORDAN, UT 84095-2249
(801) 822-2727
Mailing address
11179 IVY CREEK CV, SOUTH JORDAN, UT 84095-2249
(801) 822-2727
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
7100427-1205
UT
261QM2500X
Medical Specialty Clinic/Center
Primary
7100427-1205
UT
Other
Enumeration date
01/23/2009
Last updated
01/23/2009
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