Individual
MR. JOSEPH R TIBAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
330 CHILOQUIN BLVD, CHILOQUIN, OR 97624-6747
(541) 882-1487
(541) 783-3237
Mailing address
3949 SOUTH 6TH STREET, KLAMATH FALLS, OR 97603
(541) 882-1487
(541) 880-5590
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
966795
OR
133V00000X
Registered Dietitian
966795
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500735399
—
OR
01
—
966795
CDR REGISTRATION
—
Enumeration date
02/07/2012
Last updated
12/12/2022
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