Provider Demographics
NPI:1023039021
Name:RIEBER, GERALD M (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:RIEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-0170
Mailing Address - Country:US
Mailing Address - Phone:605-882-2630
Mailing Address - Fax:605-882-0447
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-2630
Practice Address - Fax:605-882-0447
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5045207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200044143OtherRAILROAD MEDICARE
MN249T2RIOtherBCBS
SD6402100Medicaid
SD0040322OtherBCBS
MN133780700Medicaid
SDS40322Medicare PIN
MN249T2RIOtherBCBS
SD6402100Medicaid
MN133780700Medicaid