Doctor Name: | DR. FRED BIBUS |
NPI Number: | 1386737385 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | F9200 |
Business Practice Address: | 2203 W 35th St Austin, TX - 787031203 |
Business Phone Number: | 5123746949 |
Business Fax Number: | 5123746080 |
Mailing Address: | 2203 W 35th St, AUSTIN |
State: | TX |
Postal Code: | 787031203 |
Phone Number: | 5123746949 |
Fax Number: | 5123746080 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | F9200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |