Provider Demographics
NPI:1558384941
Name:STRIBLING, FRED (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:STRIBLING
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 1:1367 E LAFAYETTE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4774
Mailing Address - Country:US
Mailing Address - Phone:850-325-6590
Mailing Address - Fax:850-325-6591
Practice Address - Street 1:1367 E LAFAYETTE ST
Practice Address - Street 2:SUITE B
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4774
Practice Address - Country:US
Practice Address - Phone:850-325-6590
Practice Address - Fax:850-325-6591
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK226782084P0800X
FLME711922084P0800X
PAMD058533L2084P0800X
WAMD 000476932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200026170AMedicaid
OK200026170BMedicaid
OK248402701Medicare ID - Type UnspecifiedINDIVIDUAL
FLK6726Medicare ID - Type UnspecifiedGROUP
OK200026170AMedicaid
OK200026170BMedicaid
OK800522325Medicare ID - Type UnspecifiedGROUP