Provider Demographics
NPI:1801802665
Name:TIBBALS, BENJAMIN VANCE (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:VANCE
Last Name:TIBBALS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3005 112TH AVE NE
Mailing Address - Street 2:STE 210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8015
Mailing Address - Country:US
Mailing Address - Phone:425-822-8888
Mailing Address - Fax:425-822-8890
Practice Address - Street 1:3005 112TH AVE NE
Practice Address - Street 2:STE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8015
Practice Address - Country:US
Practice Address - Phone:425-822-8888
Practice Address - Fax:425-822-8890
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046471207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464273Medicaid
WA8464273Medicaid
WA8864623Medicare PIN