Organization
TERESA J TIBBETTS M D LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA J TIBBETTS MD (OWNER)
(928) 680-4233
Entity
Organization
Contact information
Practice address
2082 MESQUITE AVE, SUITE A106, LAKE HAVASU CITY, AZ 86403-6710
(928) 680-4233
(928) 680-6522
Mailing address
PO BOX 2325, LAKE HAVASU CITY, AZ 86405-2325
(928) 680-4233
(928) 680-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27163
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2286
HEALTH NET
—
05
—
474429
—
AZ
01
—
AZ0769200
BCBS AZ
—
01
—
DD0854
RAILROAD MEDICARE
—
Enumeration date
12/11/2007
Last updated
08/05/2008
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