Provider Demographics
NPI:1184618415
Name:LYNG HIBBARD, ANNE (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:LYNG HIBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BJC SAINT PETERS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3386
Mailing Address - Country:US
Mailing Address - Phone:636-916-9615
Mailing Address - Fax:636-916-9850
Practice Address - Street 1:201 BJC SAINT PETERS DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3091
Practice Address - Country:US
Practice Address - Phone:636-916-9615
Practice Address - Fax:636-916-9850
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD113150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203925409Medicaid
MD113150Medicare UPIN
G15452Medicare UPIN
001013675Medicare Oscar/Certification
203925409Medicare PIN
G15452Medicare UPIN