MEDICARE: DR. PETER H HIBBERD MD

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	207P00000X	Emergency Medicine Physician	C167061	CA
2	207P00000X	Emergency Medicine Physician	036.060990	IL
3	207P00000X	Emergency Medicine Physician	22597	KY
4	207P00000X	Emergency Medicine Physician	01030482A	IN
5	207P00000X	Emergency Medicine Physician	Q4426	TX
6	207P00000X	Emergency Medicine Physician	53441	CT
7	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	ME88920	FL
8	207P00000X	Emergency Medicine Physician	ME88920	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	50933E	OTHER	FL	MEDICARE PTAN PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14260985	OTHER		CAQH
4	CAMD-0099-0975	OTHER		MEDICAL IDENTIFICATION NUMBER FOR CANADA MINC
5	50399	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1639262959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER H HIBBERD MD

Provider Business Mailing Address
First Line	:	277 ROYAL POINCIANA WAY UNIT 141
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4007
Country	:	US
Telephone Number	:	561-725-2356
Fax Number	:	561-655-7245

Provider Business Practice Location Address
First Line	:	277 ROYAL POINCIANA WAY UNIT 141
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4007
Country	:	US
Telephone Number	:	561-655-4477
Fax Number	:	561-655-7245

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	12/31/2022

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Directions to “ DR. PETER H HIBBERD MD” Practice Location

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