Individual
DR. FREDRICK S DIBRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
136 WHEELERTOWN AVENUE, PIKEVILLE, TN 37367-5247
(423) 447-3524
(423) 447-3621
Mailing address
PO BOX 11527, CHATTANOOGA, TN 37401-2527
(423) 778-3274
(423) 778-2255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45770
TN
207R00000X
Internal Medicine Physician
E1622
AR
208000000X
Pediatrics Physician
45770
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134513001
—
AR
05
—
1517996
—
TN
01
—
18437000000
QUALCHOICE
AR
01
—
5K789
BLUE CROSS BLUE SHIELD
AR
01
—
P0117339
RAILROAD MEDICARE
AR
Enumeration date
07/21/2006
Last updated
10/27/2014
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