Individual
CHARLES KELLEY TIBBELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1821 S FM 51, DECATUR, TX 76234-3715
(940) 233-6929
(877) 892-4569
Mailing address
1821 S FM 51, DECATUR, TX 76234-3715
(940) 233-6929
(877) 892-4569
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E6655
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080094585
RAILROAD MEDICARE
TX
05
—
136230301
—
TX
05
—
136230311
—
TX
01
—
8EG149
BCBSTX
TX
01
—
P00362520
RAILROAD MEDICARE-AMC
TX
Enumeration date
02/23/2006
Last updated
09/17/2024
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