Individual
DR. PEDRO H IBARRA-PEROCIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 WASHINGTON AVE NW, WAGNER, SD 57380-4300
(605) 384-3621
(605) 384-5229
Mailing address
111 WASHINGTON AVE NW, WAGNER, SD 57380-4300
(605) 384-3621
(605) 384-5229
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
14413
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100284W
MEDICARE Y MUCHO MAS
PR
01
—
1326066796
I.H.S. WAGNER
SD
01
—
3258
PREFERRED MEDICARE CHOICE
PR
01
—
A468
FIRST MEDICAL
PR
Enumeration date
12/01/2005
Last updated
10/24/2011
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