Healthcare Provider Details

I. General information

NPI: 1982629226
Provider Name (Legal Business Name): FRANK GERHARDT BIEBERLY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 160 & NAVAJO ROUTE 25 - RED MESA
TEECNOSPOS AZ
86514
US

IV. Provider business mailing address

HCR 6100 BOX 30
TEECNOSPOS AZ
86514
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5000
  • Fax: 505-368-6431
Mailing address:
  • Phone: 928-656-5000
  • Fax: 505-368-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1275
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: