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General NPI Number Information
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NPI Number | 1386737385
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Entity Type | Individual
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Provider Name | FRED BIBUS MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2203 W 35TH ST
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City | AUSTIN
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State | TX
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Zip | 78703-1203
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Country | US
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Telephone | 512-374-6949
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Fax | 512-374-6080
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Provider Business Mailing Address
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Address Line | 2203 W 35TH ST
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City | AUSTIN
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State | TX
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Zip | 78703-1203
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Country | US
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Telephone | 512-374-6949
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Fax | 512-374-6080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | F9200
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License Number State | TX
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