Provider Demographics
NPI:1023253101
Name:DAVID B BYBEE MD INC
Entity type:Organization
Organization Name:DAVID B BYBEE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:BYBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-571-0288
Mailing Address - Street 1:PO BOX 22955
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4480
Mailing Address - Country:US
Mailing Address - Phone:209-571-0288
Mailing Address - Fax:209-571-0327
Practice Address - Street 1:4016 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9268
Practice Address - Country:US
Practice Address - Phone:209-571-0288
Practice Address - Fax:209-571-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2023-10-02
Deactivation Date:2019-06-12
Deactivation Code:
Reactivation Date:2020-01-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G693340Medicaid
CAE63936Medicare UPIN
CA00G693340Medicaid