Provider Demographics
NPI:1154436517
Name:TIBBELS, TERRENCE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:EDWARD
Last Name:TIBBELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3991 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3625
Mailing Address - Country:US
Mailing Address - Phone:760-729-5031
Mailing Address - Fax:
Practice Address - Street 1:9745 PROSPECT AVE
Practice Address - Street 2:#100
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6209
Practice Address - Country:US
Practice Address - Phone:619-448-4841
Practice Address - Fax:619-448-8700
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31826208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice