Provider Demographics
NPI:1508035262
Name:TISBE, CARLOS T (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:T
Last Name:TISBE
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 1:7326 W CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6201
Mailing Address - Country:US
Mailing Address - Phone:702-386-4700
Mailing Address - Fax:702-386-4701
Practice Address - Street 1:7326 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6201
Practice Address - Country:US
Practice Address - Phone:702-386-4700
Practice Address - Fax:702-386-4701
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10770207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
V105416Medicare UPIN