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General NPI Number Information
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NPI Number | 1891817565
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Entity Type | Individual
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Provider Name | JUAN M IBARRA MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 1045 W STEPHENSON ST
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City | FREEPORT
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State | IL
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Zip | 61032-4864
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Country | US
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Telephone | 815-599-6159
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Fax |
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Provider Business Mailing Address
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Address Line | 2830 MARVIN LN
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City | FREEPORT
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State | IL
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Zip | 61032-9315
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Country | US
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Telephone | 815-235-7093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036082621
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036082621
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License Number State | IL
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