Healthcare Provider Details

I. General information

NPI: 1386737385
Provider Name (Legal Business Name): FRED BIBUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 W 35TH ST
AUSTIN TX
78703-1203
US

IV. Provider business mailing address

2203 W 35TH ST
AUSTIN TX
78703-1203
US

V. Phone/Fax

Practice location:
  • Phone: 512-374-6949
  • Fax: 512-374-6080
Mailing address:
  • Phone: 512-374-6949
  • Fax: 512-374-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF9200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: