Provider Demographics
NPI:1417011321
Name:GIEBEIG FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:GIEBEIG FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:GIEBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-752-0090
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-0159
Mailing Address - Country:US
Mailing Address - Phone:386-752-0090
Mailing Address - Fax:386-719-9494
Practice Address - Street 1:5085 WEST US HWY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055
Practice Address - Country:US
Practice Address - Phone:386-752-0090
Practice Address - Fax:386-719-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2314Medicare ID - Type Unspecified