# TERESA J TIBBETTS M D LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053594275
- **Authorized official:** TERESA J TIBBETTS MD (OWNER)
- **Authorized official phone:** (928) 680-4233

## Contact information

- **Practice address:** 2082 MESQUITE AVE, SUITE A106, LAKE HAVASU CITY, AZ 86403-6710
- **Practice address phone:** (928) 680-4233
- **Practice address fax:** (928) 680-6522
- **Mailing address:** PO BOX 2325, LAKE HAVASU CITY, AZ 86405-2325
- **Mailing address phone:** (928) 680-4233
- **Mailing address fax:** (928) 680-6522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 27163 | AZ | Yes |

## Other

- **Enumeration date:** 12/11/2007
- **Last updated:** 08/05/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2Z2286 | HEALTH NET | — |
| 05 | — | 474429 | — | AZ |
| 01 | — | AZ0769200 | BCBS AZ | — |
| 01 | — | DD0854 | RAILROAD MEDICARE | — |