Individual
MR. ROBERT J JIBBEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1523 BUSINESS HWY 60 W, STE A1, DEXTER, MO 63841
(573) 624-8447
Mailing address
PO BOX 472, DEXTER, MO 63841-0472
(573) 624-8447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DOR5B81
MO
207Q00000X
Family Medicine Physician
R5B81
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212875
BLUE CROSS BLUE SHIELD
—
05
—
241863935
—
MO
01
—
765432
HEALTHLINK
MO
01
—
P00391083
RAILROAD MEDICARE
MO
Enumeration date
10/14/2005
Last updated
01/06/2014
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