Brian T. McKibben, MD

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

ME40936 Issued in FL

Legal business name

BRIAN T. MCKIBBEN, MD

Practice address

1515 May St
Jacksonville, FL 32204-4007

Phone

(904) 353-5921

Fax

(904) 353-5920

NPI assigned

Feb 11, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Thomas McKibben, M.D.NPI 1609828557

Title

Healthcare Provider

Phone

(904) 353-5921

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian Thomas McKibben, M.D.

  • Colon & Rectal Surgery Physician
  • Jacksonville, FL
  • NPI 1609828557
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1447641592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MAY ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044007",
            "telephone_number": "904-353-5921",
            "fax_number": "904-353-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 MAY ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044007",
            "telephone_number": "904-353-5921",
            "fax_number": "904-353-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN T. MCKIBBEN, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "MCKIBBEN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "HEALTHCARE PROVIDER",
        "authorized_official_telephone_number": "904-353-5921",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "FL",
            "license": "ME40936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050010100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Brewer, LMHC
• Megan K Brewer
• Nekeeya K Brewster
• Elizabeth Breza, ARNP-BC
• Brian S Armitage, O.D., P.a. (Baymeadows Vision Center)
• Mary Elizabeth Briand, PHARMD, BCPS, CGP
• Lee Allan Brice, R.PH.
• Verlon Coy Brickey Jr., PHD., LMHC, CAP
• Kelly J Brickman
• John Brideau

• Colon & Rectal Surgery Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Colon & Rectal Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.