Provider Demographics
NPI:1801844824
Name:HIEB, RICHARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:HIEB
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 1:400 22ND AVE.
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2497
Mailing Address - Country:US
Mailing Address - Phone:605-697-9500
Mailing Address - Fax:609-697-6939
Practice Address - Street 1:400 22ND AVE.
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2497
Practice Address - Country:US
Practice Address - Phone:605-697-9500
Practice Address - Fax:609-697-6939
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5607692Medicaid
SDS42287Medicare PIN
SD5607692Medicaid