Provider Demographics
NPI:1255420386
Name:HEBBAR, NERIA H (MD)
Entity type:Individual
Prefix:DR
First Name:NERIA
Middle Name:H
Last Name:HEBBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5347 MAIN STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2533
Mailing Address - Country:US
Mailing Address - Phone:727-845-1662
Mailing Address - Fax:727-841-7579
Practice Address - Street 1:5347 MAIN STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2533
Practice Address - Country:US
Practice Address - Phone:727-845-1662
Practice Address - Fax:727-841-7579
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME40554208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4113066OtherAETNA PROVIDER NUMBER
232066OtherWELLCARE PROVIDER NUMBER
FL264853900Medicaid
280000068OtherRAILROAD MEDICARE PTAN
205085OtherAVMED PROVIDER NUMBER
FL51180OtherBLUE SHIELD PROVIDER NUM
06271OtherUNIVERSAL PROVIDER NUMBER
06271OtherUNIVERSAL PROVIDER NUMBER
205085OtherAVMED PROVIDER NUMBER