Provider Demographics
NPI:1538494232
Name:TIBBETTS, BRADLEY CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CHARLES
Last Name:TIBBETTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HHB, 6-37 FA
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224
Mailing Address - Country:US
Mailing Address - Phone:0103-105-4639
Mailing Address - Fax:
Practice Address - Street 1:HQ BAACH USAMEDDAC KOREA
Practice Address - Street 2:UNIT # 15244
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5244
Practice Address - Country:US
Practice Address - Phone:0103-105-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant