Provider Demographics
NPI:1649289638
Name:HIBARGER, WALTER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAMES
Last Name:HIBARGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19847 HWY H
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MO
Mailing Address - Zip Code:64098-9115
Mailing Address - Country:US
Mailing Address - Phone:816-386-2659
Mailing Address - Fax:
Practice Address - Street 1:491 N YUCCA ST US HIGHWAY
Practice Address - Street 2:NORTHERN NAVAJO MEDICAL CENTER
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-0160
Practice Address - Country:US
Practice Address - Phone:505-368-6001
Practice Address - Fax:505-368-6599
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5473207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49288067Medicaid
NM64200345Medicaid
AZ836207Medicaid
NM64200345Medicaid
8HF575Medicare PIN
CO49288067Medicaid