MEDICARE: GIEBEIG FAMILY MEDICINE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417011321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIEBEIG FAMILY MEDICINE PA

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-0159
Country	:	US
Telephone Number	:	386-752-0090
Fax Number	:	386-719-9494

Provider Business Practice Location Address
First Line	:	5085 WEST US HWY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055
Country	:	US
Telephone Number	:	386-752-0090
Fax Number	:	386-719-9494

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. PETER WENDELL GIEBERG JR.
Credential	:	MD
Telephone Number	:	386-752-0090

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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Directions to “GIEBEIG FAMILY MEDICINE PA ” Practice Location

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