Bear River Urology, LLC

NPI #1063708592 in Evanston, Wyoming

Provider Information

NPI Number: 1063708592
Entity Type: Organization
Organization Name: Bear River Urology, LLC
Primary Specialty: Urology
Enumeration Date: Jun 23, 2011
Last Updated: Jun 23, 2011

Practice Location

Address: 196 ARROWHEAD DR
Address 2: SUITE #4
City: Evanston
State: Wyoming
ZIP Code: 82930-8752
Phone: (307) 789-8721

Authorized Official

Name: MICHAEL E VAN BIBBER, MD
Title: OWNER
Phone: (801) 821-6717

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Urology	208800000X	Primary

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