Provider Demographics
NPI:1528873775
Name:TRIBBLE, MAURICE B
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:B
Last Name:TRIBBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 MONTYS CIR N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-9120
Mailing Address - Country:US
Mailing Address - Phone:580-514-8301
Mailing Address - Fax:
Practice Address - Street 1:1641 MONTYS CIR N
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-9120
Practice Address - Country:US
Practice Address - Phone:580-514-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver