Provider Demographics
NPI:1437130184
Name:SHIBER, JOSEPH R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:SHIBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP-PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1013207P00000X
TXN4745207P00000X
FLME100022207RC0200X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207763803Medicaid
TXP00838042OtherMEDICARE RAILROAD
TX1437130184OtherBLUE CROSS BLUE SHIELD
NC129EYOtherBCBS NC
NC89129EYMedicaid
GA003105970AMedicaid
FL279791701Medicaid
NC930113588OtherRAILROAD MEDICARE
TX1437130184OtherBLUE CROSS BLUE SHIELD
NE$$$$$$$$$Medicaid
TX207763803Medicaid
TX1437130184OtherBLUE CROSS BLUE SHIELD
NC129EYOtherBCBS NC
TXTXB102654Medicare PIN