Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | G37140 | CA |
NPI | 1649361668 |
---|---|
Provider Name | Dr. John Parsons Hibbard |
First Address | Santa Rosa, CA 95404-3927 |
Second Address | Santa Rosa, CA 95401-4282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46970 | (02) | CA |