Provider Demographics
NPI:1699838003
Name:GIEBEIG, PETER WENDELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WENDELL
Last Name:GIEBEIG
Suffix:JR
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 1:5085 WEST US HWY 90
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46281OtherBCBS
DB0176OtherRAILROAD MEDICARE
FL258476000Medicaid
FLBG5555391OtherDEA
FL46281ZMedicare ID - Type Unspecified
FLBG5555391OtherDEA