Provider Demographics
NPI:1205825841
Name:DIBBLE, PAUL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:DIBBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18423 FM 1488 RD STE C
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8512
Mailing Address - Country:US
Mailing Address - Phone:281-259-7400
Mailing Address - Fax:888-502-3566
Practice Address - Street 1:18423 FM 1488 RD STE C
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8512
Practice Address - Country:US
Practice Address - Phone:281-259-7400
Practice Address - Fax:888-502-3566
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5315033187207Q00000X
TXP0576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16011013Medicare PIN