Basic Information
| Provider Information | |||||||||
| NPI: | 1528043346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIBBLE | ||||||||
| FirstName: | BRENDAN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1028 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921021906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602939392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 131 PROVIDENCE RD DEPT OF | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2013-01939 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.