Provider Demographics
NPI:1881733889
Name:BIBB, JOHN LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LUIS
Last Name:BIBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8283 N HAYDEN RD STE 155
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2455
Mailing Address - Country:US
Mailing Address - Phone:480-278-8861
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:8283 N HAYDEN RD STE 155
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2455
Practice Address - Country:US
Practice Address - Phone:480-278-8861
Practice Address - Fax:480-882-5018
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ36673207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212864Medicaid
AZ212864Medicaid