Healthcare Provider Details

I. General information

NPI: 1609851492
Provider Name (Legal Business Name): TIMOTHY C HIEBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 MAIN ST
MOSS POINT MS
39563-5102
US

IV. Provider business mailing address

PO BOX 3590
VICTORIA TX
77903-3590
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-6111
  • Fax: 225-474-6113
Mailing address:
  • Phone: 228-474-6111
  • Fax: 361-576-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD16489
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: