Individual
DR. EWING TIBBELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
477 E BEAVER AVE, STATE COLLEGE, PA 16801-5633
(814) 339-7101
(814) 339-6165
Mailing address
PO BOX 592, CLEARFIELD, PA 16830-0592
(814) 339-7101
(814) 339-6165
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD026959L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006594400005
—
PA
Enumeration date
10/04/2006
Last updated
10/26/2007
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