Provider Demographics
NPI:1922079128
Name:DR. ERIC TIBLIER, P.A.
Entity Type:Organization
Organization Name:DR. ERIC TIBLIER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:TIBLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-206-2988
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6767207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007MQOtherBCBS OF TEXAS GROUP #
TX173181201Medicaid
TX00847YMedicare PIN
TX007MQOtherBCBS OF TEXAS GROUP #