Provider Demographics
NPI:1508963489
Name:NIBLEY, CARLETON THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLETON
Middle Name:THOMAS
Last Name:NIBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:SUITE 319
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-674-2880
Practice Address - Fax:925-674-2883
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81444207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ27532ZOtherMEDICARE GROUP NUMBER
CAP00082303OtherRAILROAD MEDICARE
CADB0077OtherRAILROAD MC GRP NUMBER
CA035185OtherHILL PHYSICIANS PROV NUM
CAG81444Medicaid
CAGR0098120Medicaid
CAP01312627OtherRAILROAD MEDICARE (JMH)
CAZZZ07991ZOtherBLUE SHIELD GROUP NUMBER
CA035185OtherHILL PHYSICIANS PROV NUM
CADB0077OtherRAILROAD MC GRP NUMBER
CAP01312627OtherRAILROAD MEDICARE (JMH)