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General NPI Number Information
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NPI Number | 1295889574
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY OF SOUTHEASTERN OHIO, INC.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 751 FOREST AVE STE 201
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City | ZANESVILLE
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State | OH
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Zip | 43701
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Country | US
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Telephone | 740-454-7546
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Fax | 740-454-6760
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Provider Business Mailing Address
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Address Line | 751 FOREST AVE STE 201
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City | ZANESVILLE
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State | OH
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Zip | 43701-2875
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Country | US
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Telephone | 740-454-7546
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Fax | 740-454-6760
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. JOHN P. HIBLER
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Credential | D.O.
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Telephone | 740-454-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 34004301
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License Number State | OH
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