Provider Demographics
NPI:1518262369
Name:CARLOS DIBBLE, MD LLC
Entity Type:Organization
Organization Name:CARLOS DIBBLE, MD LLC
Other - Org Name:BRIGHAM CITY WOMEN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-723-6191
Mailing Address - Street 1:980 MEDICAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3094
Mailing Address - Country:US
Mailing Address - Phone:435-723-6191
Mailing Address - Fax:
Practice Address - Street 1:980 MEDICAL DR STE 1
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3094
Practice Address - Country:US
Practice Address - Phone:435-723-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty