Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | N1474 | TX |
NPI | 1013953900 |
---|---|
Provider Name | Ryan Michael Tibbetts |
First Address | Austin, TX 78759-4107 |
Second Address | Austin, TX 78759-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203614704 | (05) | TX |
203614705 | (05) | TX |