Provider Demographics
NPI:1154671758
Name:ROCKY EIBERT MD PA
Entity Type:Organization
Organization Name:ROCKY EIBERT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:
Authorized Official - Last Name:EIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-846-1155
Mailing Address - Street 1:6730 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2842
Mailing Address - Country:US
Mailing Address - Phone:727-846-1155
Mailing Address - Fax:727-846-1247
Practice Address - Street 1:6730 CONGRESS STREET
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2842
Practice Address - Country:US
Practice Address - Phone:727-846-1155
Practice Address - Fax:727-846-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068008700Medicaid
FL068008700Medicaid
FL51179Medicare PIN