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General NPI Number Information
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NPI Number | 1679577639
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Entity Type | Individual
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Provider Name | LUIS A. DIBOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 5147 N 9TH AVE STE 318
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City | PENSACOLA
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State | FL
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Zip | 32504-8710
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Country | US
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Telephone | 850-416-2965
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Fax | 850-416-1833
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD STE 4015
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3623
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Country | US
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Telephone |
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Fax |
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME128360
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License Number State | FL
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