MEDICARE: DR. ROBERT B DIBBLE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY9247	CA

General Provider Information

NPI Number	:	1003805938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT B DIBBLE PH.D.

Provider Business Mailing Address
First Line	:	ALPINE CENTER
Second Line	:	375 EAST LINE ST
City	:	BISHOP
State	:	CA
Zip	:	93514-3566
Country	:	US
Telephone Number	:	760-873-4357
Fax Number	:	760-873-7446

Provider Business Practice Location Address
First Line	:	ALPINE CENTER
Second Line	:	375 EAST LINE ST
City	:	BISHOP
State	:	CA
Zip	:	93514-3566
Country	:	US
Telephone Number	:	760-873-4357
Fax Number	:	760-873-7446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/24/2013

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