Provider Demographics
NPI:1730478348
Name:TIBBAR MEDICAL PLLC
Entity Type:Organization
Organization Name:TIBBAR MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKELINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GOMEZ JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-962-8375
Mailing Address - Street 1:401 MIRACLE MILE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-962-8375
Mailing Address - Fax:
Practice Address - Street 1:401 MIRACLE MILE
Practice Address - Street 2:SUITE 103
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-962-8375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 667522085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty