Provider Demographics
NPI:1528043346
Name:TRIBBLE, BRENDAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:THOMAS
Last Name:TRIBBLE
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 1:1028 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1906
Mailing Address - Country:US
Mailing Address - Phone:360-293-9392
Mailing Address - Fax:
Practice Address - Street 1:131 PROVIDENCE RD DEPT OF
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1206
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01939207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology