Healthcare Provider Details

I. General information

NPI: 1154361855
Provider Name (Legal Business Name): DAVID BRUCE TRIBBLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 HOMESTEAD RD
FORT WAYNE IN
46814-4202
US

IV. Provider business mailing address

5910 HOMESTEAD RD
FORT WAYNE IN
46814-4202
US

V. Phone/Fax

Practice location:
  • Phone: 574-226-3382
  • Fax:
Mailing address:
  • Phone: 574-226-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01039289
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number44186
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME120871
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01039289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: