Basic Information
| Provider Information | |||||||||
| NPI: | 1982629226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIEBERLY | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | GERHARDT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | HCR 6100 BOX 30 | ||||||||
| Address2: | |||||||||
| City: | TEECNOSPOS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 5053686431 | ||||||||
| Practice Location | |||||||||
| Address1: | US HWY 160 & NAVAJO ROUTE 25 - RED MESA | ||||||||
| Address2: | |||||||||
| City: | TEECNOSPOS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 5053686431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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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 | 207R00000X | 1275 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 48280771 | 05 | NM | MEDICAID |