Provider Demographics
NPI:1346403912
Name:TIBBLE, COURTNEY A (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:A
Last Name:TIBBLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1020 29TH STREET
Practice Address - Street 2:SUITE 270
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5125
Practice Address - Country:US
Practice Address - Phone:916-455-3700
Practice Address - Fax:916-733-3035
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2015-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA103174207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT270YMedicare PIN