Organization
PREMIER GASTROENTEROLOGY PA
Active
Organization
PREMIER GASTROENTEROLOGY PA
Active
Other names
M Rodwan Hiba
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUHAMMED-RODWAN ALI HIBA MD (OWNER/CEO)
(352) 597-4000
Entity
Organization
Contact information
Practice address
12102 CORTEZ BLVD, BROOKSVILLE, FL 34613-5514
(352) 597-4000
(352) 597-0550
Mailing address
12102 CORTEZ BLVD, BROOKSVILLE, FL 34613-5514
(352) 597-4000
(352) 597-0550
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME69833
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100016261
RAILROAD MEDICARE
—
01
—
1003105
HUMANA
—
01
—
2119601215701
BEECH ST
—
05
—
2579162-0
—
FL
01
—
2593473
GHI
—
01
—
2987121
UHC
—
01
—
360846358
FIRST HEALTH
—
01
—
49489
BCBS
—
01
—
7130182
AETNA
—
Enumeration date
08/24/2006
Last updated
06/10/2024
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