Provider Demographics
NPI:1043299258
Name:FIEBER, MARY CAROLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROLINE
Last Name:FIEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 N. VAN BUREN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1713
Mailing Address - Country:US
Mailing Address - Phone:580-237-0171
Mailing Address - Fax:580-237-0412
Practice Address - Street 1:2609 N. VAN BUREN
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1713
Practice Address - Country:US
Practice Address - Phone:580-237-0171
Practice Address - Fax:580-237-0412
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24212207ZP0102X, 207ZC0500X
CAG62349207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200050450AMedicaid
CALAB44024FMedicaid
CAZZZ58613ZMedicare PIN
E80118Medicare UPIN
CAE80118Medicare PIN
OK249502001Medicare ID - Type Unspecified
OK200050450AMedicaid
ZZZ58613ZMedicare PIN