Provider Demographics
NPI:1467418582
Name:RIBNER, ANDREW BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRUCE
Last Name:RIBNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 G ST STE 240
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5670
Mailing Address - Country:US
Mailing Address - Phone:530-844-4656
Mailing Address - Fax:
Practice Address - Street 1:414 G ST STE 240
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5670
Practice Address - Country:US
Practice Address - Phone:530-844-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0117207YS0123X
VA0101234824207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47514Medicare UPIN
VA020044L26Medicare ID - Type Unspecified
VA020044L26Medicare ID - Type UnspecifiedGROUP