MEDICARE: DR. PRUDENCIO GALVEZ TIBLE MD

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	208D00000X	General Practice Physician	MD00022189	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679663884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRUDENCIO GALVEZ TIBLE MD

Provider Business Mailing Address
First Line	:	PO BOX 18936
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118
Country	:	US
Telephone Number	:	206-725-8043
Fax Number	:	206-760-1359

Provider Business Practice Location Address
First Line	:	5023 S BARTON PLACE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118
Country	:	US
Telephone Number	:	206-725-8043
Fax Number	:	206-760-1359

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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