Provider Demographics
NPI:1275838088
Name:BARBARO DIEBER, TINA GRACE (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:GRACE
Last Name:BARBARO DIEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:750 8TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2500
Practice Address - Country:US
Practice Address - Phone:682-885-2170
Practice Address - Fax:817-335-8277
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7216207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220028901Medicaid
TX220028908OtherCSHCN
TX220028903Medicaid
TX220028905OtherCSHCN
TX220028906OtherCSHCN
TX220028907OtherCSHCN
TX220028904Medicaid
TX220028902Medicaid
TX220028906OtherCSHCN