=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821036336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD TRIBBEY D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 08/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 JACKSON ST SW
-----------------------------------------------------
City | GRAVETTE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72736-9121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-787-5291
-----------------------------------------------------
Fax | 479-344-6404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 JACKSON ST SW
-----------------------------------------------------
City | GRAVETTE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72736-9121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-787-5291
-----------------------------------------------------
Fax | 479-344-6404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 2001013823
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2001013823
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | E5531
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------