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NPI Code Detail

MEDICARE: BRIAN IGONI WARIBOKO M.D

MEDICARE: BRIAN IGONI WARIBOKO M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician61928MN

General Provider Information

NPI Number : 1457779563
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN IGONI WARIBOKO M.D
Provider Business Mailing Address
First Line : 12200 WARWICK BLVD
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23601-2344
Country : US
Telephone Number : 757-534-6111
Fax Number :
Provider Business Practice Location Address
First Line : 300 STATE AVE
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-6319
Country : US
Telephone Number : 507-333-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2014
Last Update Date : 01/07/2021

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