Provider Demographics
NPI:1699749226
Name:HIBBS, DOUGLAS B (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:HIBBS
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 1:1400 BOWIE CIR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1005
Mailing Address - Country:US
Mailing Address - Phone:903-654-2781
Mailing Address - Fax:
Practice Address - Street 1:9221 LBJ FWY
Practice Address - Street 2:SUITE 208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3455
Practice Address - Country:US
Practice Address - Phone:972-644-8577
Practice Address - Fax:972-644-8056
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W9562OtherBCBS
TX102139605Medicaid
TX102139603Medicaid
TX102139605Medicaid
TX8L0807Medicare PIN
TXP00424128Medicare PIN
TX8W9562OtherBCBS
F63018Medicare UPIN