Individual
CESAR B IBANEZ II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5170 US RT 60 EAST, HUNTINGTON, WV 25705
(304) 528-4600
Mailing address
5170 US RT 60 EAST, HUNTINGTON, WV 25705
(304) 528-4600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10816
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001719573
BLUE CROSS BLUE SHIELD
WV
05
—
0048653000
—
WV
05
—
0355208
—
OH
01
—
3001332
WORKERS COMPENSATION
WV
05
—
64941982
—
KY
Enumeration date
05/17/2006
Last updated
08/03/2016
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