Healthcare Provider Details

I. General information

NPI: 1316024052
Provider Name (Legal Business Name): JAMES G HIBBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LN SUITE 530
KIRKLAND WA
98034-3099
US

IV. Provider business mailing address

12303 NE 130TH LN SUITE 530
KIRKLAND WA
98034-3099
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4600
  • Fax:
Mailing address:
  • Phone: 425-899-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00030958
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: