Provider Demographics
NPI:1639262959
Name:HIBBERD, PETER H (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:HIBBERD
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 1:277 ROYAL POINCIANA WAY UNIT 141
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4007
Mailing Address - Country:US
Mailing Address - Phone:561-725-2356
Mailing Address - Fax:561-655-7245
Practice Address - Street 1:277 ROYAL POINCIANA WAY UNIT 141
Practice Address - Street 2:
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4007
Practice Address - Country:US
Practice Address - Phone:561-655-4477
Practice Address - Fax:561-655-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC167061207P00000X
IL036.060990207P00000X
KY22597207P00000X
IN01030482A207P00000X
TXQ4426207P00000X
CT53441207P00000X
FLME88920207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271391800Medicaid
14260985OtherCAQH
FL50933EOtherMEDICARE PTAN PROVIDER NUMBER
CAMD-0099-0975OtherMEDICAL IDENTIFICATION NUMBER FOR CANADA MINC
FL50399OtherBCBS OF FLORIDA