Provider Demographics
NPI:1659661924
Name:DIBRA, MARIE NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:NGUYEN
Last Name:DIBRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 GAYLORD PKWY # 1190
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9416
Mailing Address - Country:US
Mailing Address - Phone:844-409-4657
Mailing Address - Fax:214-614-4277
Practice Address - Street 1:3800 GAYLORD PKWY # 1190
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9416
Practice Address - Country:US
Practice Address - Phone:184-440-9465
Practice Address - Fax:214-614-4277
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120010207R00000X, 207RS0012X
TXS5360207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012037300Medicaid
FLHU518YMedicare PIN
FLHU518ZMedicare PIN