Basic Information
| Provider Information | |||||||||
| NPI: | 1508963489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIBLEY | ||||||||
| FirstName: | CARLETON | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 34929 | ||||||||
| Address2: | P.O. BOX 39000 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941390001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259522828 | ||||||||
| FaxNumber: | 9259522850 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 GRANT ST | ||||||||
| Address2: | SUITE 319 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945202266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256742880 | ||||||||
| FaxNumber: | 9256742883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | G81444 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | G81444 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | ZZZ27532Z | 01 | MEDICARE GROUP NUMBER | OTHER | P00082303 | 01 | CA | RAILROAD MEDICARE | OTHER | DB0077 | 01 | CA | RAILROAD MC GRP NUMBER | OTHER | 035185 | 01 | CA | HILL PHYSICIANS PROV NUM | OTHER | G81444 | 05 | CA | MEDICAID | GR0098120 | 05 | CA | MEDICAID | P01312627 | 01 | CA | RAILROAD MEDICARE (JMH) | OTHER | ZZZ07991Z | 01 | CA | BLUE SHIELD GROUP NUMBER | OTHER |