Provider Demographics
NPI:1013937556
Name:TIBILETTI, CLAIRE (MD)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:
Last Name:TIBILETTI
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 1:3414 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8336
Mailing Address - Country:US
Mailing Address - Phone:903-939-7500
Mailing Address - Fax:800-248-0426
Practice Address - Street 1:3414 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8336
Practice Address - Country:US
Practice Address - Phone:903-939-7500
Practice Address - Fax:800-248-0426
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3856208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00063083OtherRAILROAD MEDICARE INDIVIDUAL
TX162224301Medicaid
TXY0051795OtherDPS #
TXDA5545OtherRAILROAD MEDICARE GROUP
TX0037KVOtherBLUE CROSS GROUP #
TX8B2613Medicare PIN
TXY0051795OtherDPS #
TXP00063083OtherRAILROAD MEDICARE INDIVIDUAL