MEDICARE: DR. WALTER JAMES HIBARGER 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	207Q00000X	Family Medicine Physician	C5473	AR
2	207P00000X	Emergency Medicine Physician	C5473	AR

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649289638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER JAMES HIBARGER MD

Provider Business Mailing Address
First Line	:	19847 HWY H
Second Line	:
City	:	WESTON
State	:	MO
Zip	:	64098-9115
Country	:	US
Telephone Number	:	816-386-2659
Fax Number	:

Provider Business Practice Location Address
First Line	:	491 N YUCCA ST US HIGHWAY
Second Line	:	NORTHERN NAVAJO MEDICAL CENTER
City	:	SHIPROCK
State	:	NM
Zip	:	87420-0160
Country	:	US
Telephone Number	:	505-368-6001
Fax Number	:	505-368-6599

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	04/23/2008

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