MEDICARE: DR. PAUL JAMES DIBBLE M.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	207Q00000X	Family Medicine Physician	5315033187	MI
2	207Q00000X	Family Medicine Physician	P0576	TX

General Provider Information

NPI Number	:	1205825841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JAMES DIBBLE M.D.

Provider Business Mailing Address
First Line	:	827 S MAGNOLIA BLVD SUITE 6
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77355
Country	:	US
Telephone Number	:	281-259-7400
Fax Number	:	888-502-3566

Provider Business Practice Location Address
First Line	:	827 S MAGNOLIA BLVD SUITE 6
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77355
Country	:	US
Telephone Number	:	281-259-7400
Fax Number	:	888-502-3566

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	12/18/2025

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