Individual
ANITA L TRIBBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Mailing address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
07729
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010762
—
MS
05
—
1196380
—
LA
01
—
5255082
AETNA
MS
01
—
58754870D
BCBS
MS
Enumeration date
06/30/2006
Last updated
07/30/2008
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