MEDICARE: JAVIER BIBB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	14199803-1205	UT
2	207RN0300X	Nephrology Physician	35802	AZ

General Provider Information

NPI Number	:	1871513358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER BIBB M.D.

Provider Business Mailing Address
First Line	:	5285 S 400 E STE B
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-7194
Country	:	US
Telephone Number	:	801-779-3500
Fax Number	:	801-779-3508

Provider Business Practice Location Address
First Line	:	5285 S 400 E STE B
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405
Country	:	US
Telephone Number	:	801-779-3500
Fax Number	:	801-779-3508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/14/2025

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