MEDICARE: DR. PAUL TEBBE 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	208000000X	Pediatrics Physician	ME75303	FL

General Provider Information

NPI Number	:	1235139973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL TEBBE M.D.

Provider Business Mailing Address
First Line	:	7332 OFFICE PARK PL
Second Line	:	SUITE 103
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8241
Country	:	US
Telephone Number	:	321-435-9800
Fax Number	:	321-435-9803

Provider Business Practice Location Address
First Line	:	7332 OFFICE PARK PL
Second Line	:	SUITE 103
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8241
Country	:	US
Telephone Number	:	321-435-9800
Fax Number	:	321-435-9803

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/30/2009

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