Provider Demographics
NPI:1336178979
Name:HIBEN, EUGENE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:EDWARD
Last Name:HIBEN
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 1:13381 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1161
Mailing Address - Country:US
Mailing Address - Phone:813-983-9495
Mailing Address - Fax:813-983-9496
Practice Address - Street 1:13381 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-983-9495
Practice Address - Fax:813-983-9496
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068338208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202786569OtherTRICARE
FL202786569OtherPHCS
FL4646665OtherAETNA
FL11107101OtherCITRUS
FL206656OtherAVMED
FL202786569OtherUNITED HEALTHCARE
FL202786569OtherBEECH STREET
FL04829OtherHEALTHEASE
FL202786569OtherGREAT WEST
FL202786569OtherCIGNA
FL202786569OtherHUMANA
FL378347200Medicaid
FL04829OtherSTAYWELL
FL204612OtherAMERIGROUP
FL27158OtherBLUE SHIELD FLORIDA
FL204612OtherAMERIGROUP