Basic Information
| Provider Information | |||||||||
| NPI: | 1649361668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIBBARD | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | PARSONS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 629 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954043927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007090293 | ||||||||
| FaxNumber: | 7075767845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075760818 | ||||||||
| FaxNumber: | 7075767845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | G37140 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.