Provider Demographics
NPI:1649241803
Name:TIBLIER, ERIC STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STUART
Last Name:TIBLIER
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 1:901 W 38TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1163
Mailing Address - Country:US
Mailing Address - Phone:512-206-2988
Mailing Address - Fax:512-206-2983
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-206-2988
Practice Address - Fax:512-206-2983
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6767207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S1650OtherBCBS OF TEXAS INDIVIDUAL #
TX103494404Medicaid
TXTXB134033Medicare PIN
TX103494404Medicaid
TX8F0088Medicare PIN