Provider Demographics
NPI:1003805938
Name:DIBBLE, ROBERT B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:DIBBLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALPINE CENTER
Mailing Address - Street 2:375 EAST LINE ST
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3566
Mailing Address - Country:US
Mailing Address - Phone:760-873-4357
Mailing Address - Fax:760-873-7446
Practice Address - Street 1:ALPINE CENTER
Practice Address - Street 2:375 EAST LINE ST
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3566
Practice Address - Country:US
Practice Address - Phone:760-873-4357
Practice Address - Fax:760-873-7446
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR26744Medicare UPIN