Individual
TERESA J TIBBETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2082 MESQUITE AVE, SUITE 106, 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 PROVIDER #
AZ
05
—
474429
—
AZ
01
—
AZ0769200
BLUE CROSS BLUE SHIELD #
AZ
01
—
DD0854
RAILROAD MEDICARE GROUP #
AZ
01
—
Z102474
MEDICARE INDIVIDUAL PTAN
AZ
01
—
Z102475
MEDICARE GROUP PTAN
AZ
Enumeration date
09/14/2006
Last updated
02/09/2016
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