Healthcare Provider Details

I. General information

NPI: 1831348069
Provider Name (Legal Business Name): MR. ELMER M TRIBBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 RAINBOW SPRINGS CT APT. 5
LOUISVILLE KY
40241-2243
US

IV. Provider business mailing address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4403
  • Fax:
Mailing address:
  • Phone: 502-287-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: