1699749226 NPI number — DR. DOUGLAS B HIBBS MD

Table of content: DR. DOUGLAS B HIBBS MD (NPI 1699749226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699749226 NPI number — DR. DOUGLAS B HIBBS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIBBS
Provider First Name:
DOUGLAS
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699749226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 BOWIE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORSICANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75110-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-654-2781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9221 LBJ FWY
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-644-8577
Provider Business Practice Location Address Fax Number:
972-644-8056
Provider Enumeration Date:
02/13/2006

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: 207R00000X , with the licence number:  H9991 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8W9562 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 102139605 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102139603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com