Provider Demographics
NPI:1598827180
Name:BIBB, PHILIP WAYNE (PAC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:WAYNE
Last Name:BIBB
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:28403-6010
Mailing Address - Country:US
Mailing Address - Phone:910-763-3481
Mailing Address - Fax:910-763-3485
Practice Address - Street 1:2207 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6010
Practice Address - Country:US
Practice Address - Phone:910-763-3481
Practice Address - Fax:910-763-3485
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC101625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344723Medicare ID - Type Unspecified
S25558Medicare UPIN