Individual
JEAN HENDERSON TIBBETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
417 STATE ST, SUITE 230, BANGOR, ME 04401-6630
(207) 947-1291
(207) 947-9241
Mailing address
417 STATE ST, SUITE 230, BANGOR, ME 04401-6630
(207) 947-1291
(207) 947-9241
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
011702
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221710099
—
ME
Enumeration date
08/15/2005
Last updated
01/29/2014
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