Basic Information
| Provider Information | |||||||||
| NPI: | 1437130184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIBER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44008 | ||||||||
| Address2: | UFJP-PROVIDER ENROLLMENT | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322314008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 655 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042440411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 04/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1013 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N4745 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0200X | ME100022 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207P00000X | ME100022 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 207763803 | 05 | TX | MEDICAID | P00838042 | 01 | TX | MEDICARE RAILROAD | OTHER | 1437130184 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 129EY | 01 | NC | BCBS NC | OTHER | 89129EY | 05 | NC | MEDICAID | 003105970A | 05 | GA | MEDICAID | 279791701 | 05 | FL | MEDICAID | 930113588 | 01 | NC | RAILROAD MEDICARE | OTHER |