MEDICARE: DR. TODD AUSTIN TIBBETTS M.D., 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	2085R0202X	Diagnostic Radiology Physician	L5925	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00449060	OTHER	TX	RAILROAD MEDICARE
3	P00433521	OTHER	TX	RAILROAD MEDICARE

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
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	L5925	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1891777371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD AUSTIN TIBBETTS M.D., PH.D.

Provider Business Mailing Address
First Line	:	8401 DATAPOINT DR
Second Line	:	SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5900
Country	:	US
Telephone Number	:	210-616-7700
Fax Number	:	210-616-7709

Provider Business Practice Location Address
First Line	:	8401 DATAPOINT DR
Second Line	:	SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5900
Country	:	US
Telephone Number	:	210-616-7700
Fax Number	:	210-616-7709

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	04/07/2016

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Directions to “ DR. TODD AUSTIN TIBBETTS M.D., PH.D.” Practice Location

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