Organization
BRIAN T. MCKIBBEN, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN THOMAS MCKIBBEN M.D. (HEALTHCARE PROVIDER)
(904) 353-5921
Entity
Organization
Contact information
Practice address
1515 MAY ST, JACKSONVILLE, FL 32204-4007
(904) 353-5921
(904) 353-5920
Mailing address
1515 MAY ST, JACKSONVILLE, FL 32204-4007
(904) 353-5921
(904) 353-5920
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
ME40936
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050010100
—
FL
Enumeration date
02/11/2015
Last updated
02/11/2015
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