Healthcare Provider Details

I. General information

NPI: 1780076869
Provider Name (Legal Business Name): JOSEPH MILO HIBBERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13103 E MANSFIELD AVE
SPOKANE VALLEY WA
99216-1642
US

IV. Provider business mailing address

PO BOX 3405
SPOKANE WA
99220-3405
US

V. Phone/Fax

Practice location:
  • Phone: 509-892-2700
  • Fax: 509-892-2740
Mailing address:
  • Phone: 509-892-2700
  • Fax: 509-342-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOC-0461
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOP61550669
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number1581
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMEDPHYSCOMLIC140928
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberDO219897
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number1581
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMEDPHYSCOMLIC140928
License Number StateMT
# 8
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberOC-0461
License Number StateID
# 9
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDO219897
License Number StateOR
# 10
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberOP61550669
License Number StateWA
# 11
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberCDRH.0065668
License Number StateCO
# 12
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number222982
License Number StateAK
# 13
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number222982
License Number StateAK
# 14
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberCDRH.0065668
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: