Jacob Troy Gibby, MD
in Provo, UT. Individual provider (NPI-1).
NPI number1083174056
StatusActive
Last updated in NPPESJul 24, 2025
Details
- NPI
- 1083174056
- Entity type
- Individual (NPI-1)
- Name
- Jacob Troy Gibby
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 25, 2019
- Certification date
- Jul 24, 2025
- Last updated
- Jul 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085N0700X | 13494110-1205 | UT | Yes | |
| 2085D0003X | Radiology, Diagnostic Neuroimaging | 13494110-1205 | UT | |
| 2085R0202X | Radiology, Diagnostic Radiology | 13494110-1205 | UT |
Practice location
3152 N University Ave Ste 100Provo, UT 84604-4746
Phone 801-229-2002
Mailing address
3152 N University Ave Ste 100Provo, UT 84604-4746
Phone 801-229-2002
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