Provider Demographics
NPI:1447635677
Name:EUGENE E HIBEN MD PA
Entity type:Organization
Organization Name:EUGENE E HIBEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-983-9495
Mailing Address - Street 1:13381 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1161
Mailing Address - Country:US
Mailing Address - Phone:813-983-9495
Mailing Address - Fax:813-983-9496
Practice Address - Street 1:13381 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-983-9495
Practice Address - Fax:813-983-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68338208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378347200Medicaid
FL005NLOtherBLUE SHIELD OF FLORIDA
FL378347200Medicaid