Provider Demographics
NPI:1073513743
Name:RIBIC, JOHN R (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:RIBIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-6006
Mailing Address - Country:US
Mailing Address - Phone:406-227-1155
Mailing Address - Fax:406-227-1591
Practice Address - Street 1:4119 FOX HOLLOW DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6006
Practice Address - Country:US
Practice Address - Phone:406-227-1155
Practice Address - Fax:406-227-1591
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002534207RC0000X
WAOP60566232207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000352642OtherANTHEM
OH0395273Medicaid
A78504Medicare UPIN