Provider Demographics
NPI:1689652091
Name:GIEBINK, JAMES CONRAD (MD, FACRO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CONRAD
Last Name:GIEBINK
Suffix:
Gender:M
Credentials:MD, FACRO
Other - Prefix:
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Mailing Address - Street 1:1033 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2138
Mailing Address - Country:US
Mailing Address - Phone:321-632-0351
Mailing Address - Fax:321-361-6962
Practice Address - Street 1:1130 HICKORY ST STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-409-1956
Practice Address - Fax:321-409-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME383722085R0203X, 2085R0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372245700Medicaid
FL040897200Medicaid
FLQG681OtherHFMG MA