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General NPI Number Information
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NPI Number | 1053481598
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Entity Type | Organization
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Legal Business Name | FARMINGTON FAMILY MEDICINE PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 1401 N 1075 W SUITE # 220
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City | FARMINGTON
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State | UT
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Zip | 84025-2745
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Country | US
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Telephone | 801-451-4538
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Fax | 801-451-2295
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Provider Business Mailing Address
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Address Line | 1401 N 1075 W SUITE # 220
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City | FARMINGTON
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State | UT
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Zip | 84025-2745
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Country | US
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Telephone | 801-451-4538
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Fax | 801-451-2295
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIE HIBBARD
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Credential | M.D.
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Telephone | 801-451-4538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | UT
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