Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 28840 | AZ |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 28840 | AZ |
NPI | 1992817969 |
---|---|
Provider Name | Michael Hibner |
First Address | Los Angeles, CA 90074-0001 |
Second Address | Phoenix, AZ 85013-4224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
540353 | (05) | AZ |
H36423 | (02) | AZ |