MEDICARE: DR. CARL JOSEPH HIBBERT AU.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
1	231H00000X	Audiologist	A2573	MS

General Provider Information

NPI Number	:	1528264967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL JOSEPH HIBBERT AU.D.

Provider Business Mailing Address
First Line	:	5201 LAKELAND BLVD APT P174
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-8916
Country	:	US
Telephone Number	:	601-420-4001
Fax Number	:	601-420-4005

Provider Business Practice Location Address
First Line	:	2657 LAKELAND DR STE B
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9516
Country	:	US
Telephone Number	:	601-420-4001
Fax Number	:	601-420-4005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/09/2007

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