Provider Demographics
NPI:1073574802
Name:HILDEBRAND, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:HILDEBRAND
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 1:2730 PIERCE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3796
Mailing Address - Country:US
Mailing Address - Phone:712-234-1005
Mailing Address - Fax:712-234-0015
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:STE 300
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-234-1005
Practice Address - Fax:712-234-0015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2044016Medicaid
IAI1831Medicare ID - Type UnspecifiedMEDICARE B
IA2044016Medicaid