Active NPI
Deidre Bibb
- Sports Medicine (Preventive Medicine) Physician
- Tyler, TX
National Provider Identifier
1891269056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Preventive Medicine) Physician
- License
- 120402065-AT2240
- Practice address
- 1814 Roseland Blvd Ste 100
Tyler, TX 75701-4262 - Phone
- (903) 525-3300
- NPI assigned
- Jan 21, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Preventive Medicine) Physician | 2083S0010X | 120402065-AT2240 | TX | Primary |
Addresses
Primary practice location
1814 Roseland Blvd Ste 100
Tyler, TX 75701-4262
Mailing address
102 S Stewart St
White Oak, TX 75693-1514
Phone (903) 570-0602
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120402065-AT2240 | TX | MD | Sports Medicine (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548028800000",
"number": "1891269056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 S STEWART ST",
"city": "WHITE OAK",
"state": "TX",
"postal_code": "756931514",
"telephone_number": "903-570-0602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 ROSELAND BLVD STE 100",
"city": "TYLER",
"state": "TX",
"postal_code": "757014262",
"telephone_number": "903-525-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIBB",
"first_name": "DEIDRE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-21",
"last_updated": "2019-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2083S0010X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Sports Medicine",
"state": "TX",
"license": "120402065-AT2240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.