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Individual

MR. MILO LAVON HIBBERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
610 SUNSET DR, LA GRANDE, OR 97850-1248
(541) 963-2216
Mailing address
610 SUNSET DR, LA GRANDE, OR 97850-1248
(541) 963-2216

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD11673
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
212001
OR
01
930505325014
EMPLOYER ID NUMBER
OR
01
H1254 01
PACIFIC SOURCE
OR
Enumeration date
07/03/2006
Last updated
07/09/2007
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