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NPI Code Detail

MEDICARE: DR. JOHN PARSONS HIBBARD M.D.

MEDICARE: DR. JOHN PARSONS HIBBARD 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
1207RA0401XAddiction Medicine (Internal Medicine) PhysicianG37140CA

General Provider Information

NPI Number : 1649361668
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN PARSONS HIBBARD M.D.
Provider Business Mailing Address
First Line : 629 MONROE ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-3927
Country : US
Telephone Number : 800-709-0293
Fax Number : 707-576-7845
Provider Business Practice Location Address
First Line : 1901 CLEVELAND AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4282
Country : US
Telephone Number : 707-576-0818
Fax Number : 707-576-7845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/08/2007

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