Deidre Bibb
Preventive Medicine, Sports Medicine in Tyler, TX. Individual provider (NPI-1).
NPI number1891269056
StatusActive
Last updated in NPPESJan 21, 2019
Details
- NPI
- 1891269056
- Entity type
- Individual (NPI-1)
- Name
- Deidre Bibb
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 21, 2019
- Last updated
- Jan 21, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2083S0010X | Preventive Medicine, Sports Medicine | 120402065-AT2240 | TX | Yes |
Practice location
1814 Roseland Blvd Ste 100Tyler, TX 75701-4262
Phone 903-525-3300
Mailing address
102 S Stewart StWhite Oak, TX 75693-1514
Phone 903-570-0602
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