Healthcare Provider Details

I. General information

NPI: 1215543632
Provider Name (Legal Business Name): MARIE DIBRA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 GAYLORD PKWY # 1190
FRISCO TX
75034-9416
US

IV. Provider business mailing address

3800 GAYLORD PKWY # 1190
FRISCO TX
75034-9416
US

V. Phone/Fax

Practice location:
  • Phone: 844-409-4657
  • Fax: 214-614-4277
Mailing address:
  • Phone: 844-409-4657
  • Fax: 214-614-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIE DIBRA
Title or Position: OWNER
Credential: MD
Phone: 844-409-4657