Individual
CONRAD CURTIS GIBBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3152 N UNIVERSITY AVE, PROVO, UT 84604-4745
(801) 229-2002
Mailing address
3152 N UNIVERSITY AVE, PROVO, UT 84604-4745
(801) 229-2002
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
9724223-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
59934
AZ
2085R0204X
Vascular & Interventional Radiology Physician
Primary
9724223-1205
UT
2085R0204X
Vascular & Interventional Radiology Physician
A175297
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750624979
BCBS OF AZ
AZ
05
—
1750624979
—
AZ
01
—
Z237130
MEDICARE
AZ
Enumeration date
04/06/2013
Last updated
07/15/2022
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