Individual
DR. MICHAEL B IBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1375 ROBERTS DR, STE 204, JACKSONVILLE BEACH, FL 32250-3210
(904) 247-0056
(904) 241-0065
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
(904) 398-3262
(904) 265-4807
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
26687
TN
207RG0100X
Gastroenterology Physician
Primary
ME67895
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003230300
—
FL
01
—
14AW4
BCBS
FL
Enumeration date
05/15/2006
Last updated
05/24/2011
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