1518045921 NPI number — DR. DAVID HENRY BIBERDORF OD

Table of content: (NPI 1083303465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518045921 NPI number — DR. DAVID HENRY BIBERDORF OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIBERDORF
Provider First Name:
DAVID
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518045921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 649
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT DEFIANCE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86504-0649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-729-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CORNER OF ROUTE N12 AND N7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DEFIANCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-729-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2023 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 470 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 308723900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59775BI . This is a "BLUE PLUS OF MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60081 . This is a "ND DEPT OF HUMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60397 . This is a "VOCATIONAL REHAB CENTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140630 . This is a "U CARE MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2200440 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 59775BI . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: BIB800470 . This is a "VISION SERVICES INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410016499 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60397 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: BIB8881 . This is a "BLUE SHIELD OF ND VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 308723900 . This is a "MN DEPT OF HUMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 59775BI . This is a "MN COMPREHENSIVE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: BIB8881 . This is a "BCBS ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: BIB8881 . This is a "BLUE SHIELD OF ND ALTRU" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com