=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154671758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCKY EIBERT MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2012
-----------------------------------------------------
Last Update Date | 09/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6730 CONGRESS STREET
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-846-1155
-----------------------------------------------------
Fax | 727-846-1247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6730 CONGRESS ST
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-846-1155
-----------------------------------------------------
Fax | 727-846-1247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / PHYSICIAN
-----------------------------------------------------
Name | DR. ROCKY EIBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-846-1155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME39750
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------