Provider Demographics
NPI:1891721841
Name:VIBETO, BRETT K (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:K
Last Name:VIBETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 15TH AVE. W.
Mailing Address - Street 2:MERCY MEDICAL CENTER
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3821
Mailing Address - Country:US
Mailing Address - Phone:701-774-7400
Mailing Address - Fax:701-572-1688
Practice Address - Street 1:1213 15TH AVE. W.
Practice Address - Street 2:CRAVEN HAGAN CLINIC
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3821
Practice Address - Country:US
Practice Address - Phone:701-572-7651
Practice Address - Fax:701-572-1688
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN48079208600000X
ND10618208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13464Medicaid
MN137084OtherUCARE #
MNDA9021044154OtherPREFERRED ONE #
MN2366070OtherAMERICA'S PPO/ARAZ #
MN25809OtherNDBS #
MN44377OtherLHS #
MN1701454OtherMEDICA #
MN317S5VIOtherMNBS #
MN440683400Medicaid
MNHP53212OtherHEALTHPARTNERS #
MNP00246200Medicare ID - Type UnspecifiedRR MEDICARE #
MN440683400Medicaid
MN25809OtherNDBS #