Provider Demographics
NPI:1992917272
Name:BIBB, CHRISTOPHER ODELL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ODELL
Last Name:BIBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2386
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-2386
Mailing Address - Country:US
Mailing Address - Phone:317-507-7379
Mailing Address - Fax:512-597-2713
Practice Address - Street 1:2801 FRANCISCAN DR
Practice Address - Street 2:ST. JOSEPH REGIONAL MEDICAL CENTER, PATHOLOGY DEPT.
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2544
Practice Address - Country:US
Practice Address - Phone:979-776-5982
Practice Address - Fax:979-776-2469
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5635207ZP0102X, 207ZP0104X
IN01060395A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1927220Medicaid
TX8K4032OtherMEDICARE