Healthcare Provider Details

I. General information

NPI: 1689730293
Provider Name (Legal Business Name): VICTOR H. HILDYARD II, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SOUTH RANGE
COLBY KS
67701
US

IV. Provider business mailing address

175 SOUTH RANGE
COLBY KS
67701
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-3332
  • Fax: 785-462-3337
Mailing address:
  • Phone: 785-462-3332
  • Fax: 785-462-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKS

VIII. Authorized Official

Name: MRS. BRENDA HILDYARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-462-3332