| Doctor Name: | DR. PEDRO H IBARRA-PEROCIER |
| NPI Number: | 1710961081 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 14413 |
| Business Practice Address: | 111 Washington Ave Nw Wagner, SD - 573804300 |
| Business Phone Number: | 6053843621 |
| Business Fax Number: | 6053845229 |
| Mailing Address: | 111 Washington Ave Nw, WAGNER |
| State: | SD |
| Postal Code: | 573804300 |
| Phone Number: | 6053843621 |
| Fax Number: | 6053845229 |
| NPI Enumeration Date: | 12/01/2005 |
| NPI Last Update Date: | 10/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 14413 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |