Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01039289 | IN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 01039289A | IN |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 44186 | TN |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME120871 | FL |
NPI | 1154361855 |
---|---|
Provider Name | Dr. David Bruce Tribble |
First Address | Fort Wayne, IN 46814-4202 |
Second Address | Fort Wayne, IN 46814-4202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A48925 | (02) | IN |