Provider Demographics
NPI:1861188211
Name:HIBBERT, DAVID LEE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:HIBBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9139 S JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6611
Mailing Address - Country:US
Mailing Address - Phone:385-235-2860
Mailing Address - Fax:
Practice Address - Street 1:5373 N UNION BLVD STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2053
Practice Address - Country:US
Practice Address - Phone:719-300-5735
Practice Address - Fax:719-931-5603
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program