Provider Demographics
NPI:1598780512
Name:EIBERT, ROCKY (MD)
Entity Type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:
Last Name:EIBERT
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 1:6730 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 ST
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39750207R00000X
MO02803791123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55998Medicare UPIN
FL51179Medicare ID - Type Unspecified