Provider Demographics
NPI:1700085511
Name:BYBEE, JEAN R (PA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:R
Last Name:BYBEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W PARK STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8337
Mailing Address - Country:US
Mailing Address - Phone:936-328-5820
Mailing Address - Fax:936-328-5824
Practice Address - Street 1:210 W PARK STE 104
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8337
Practice Address - Country:US
Practice Address - Phone:936-328-5820
Practice Address - Fax:936-328-5824
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01982OtherTEXAS MEDICAL BOARD PHYSI
TX8Y2311OtherBCBS INDIVIDUAL