Healthcare Provider Details

I. General information

NPI: 1871550905
Provider Name (Legal Business Name): GIOVANNI LLIBRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 STATE FARM RD
BOONE NC
28607-4948
US

IV. Provider business mailing address

PO BOX 1490
BOONE NC
28607-1490
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-3886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9900918
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: