Provider Demographics
NPI:1518983303
Name:VANBIBER, RUSSELL C III (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:VANBIBER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 FONDREN RD., STE 255
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:832-769-3313
Mailing Address - Fax:832-769-3307
Practice Address - Street 1:2500 FONDREN RD., STE 255
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063
Practice Address - Country:US
Practice Address - Phone:832-769-3313
Practice Address - Fax:832-769-3307
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101259303Medicaid
TXB27253Medicare UPIN
TX101259303Medicaid