Provider Demographics
NPI:1205898921
Name:ZIBILICH, GEORGE J JR
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:ZIBILICH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:J
Other - Last Name:ZIBILICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1930 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3124
Mailing Address - Country:US
Mailing Address - Phone:707-616-8877
Mailing Address - Fax:
Practice Address - Street 1:3800 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4742
Practice Address - Country:US
Practice Address - Phone:707-464-6372
Practice Address - Fax:707-464-9593
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37382207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C373820Medicaid
CA00C373821Medicare ID - Type Unspecified
CA00C373820Medicaid