Basic Information
Provider Information
NPI: 1750025037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALIBIN
FirstName: ELOY
MiddleName: BIO
NamePrefix: DR.
NameSuffix: III
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1202 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984053926
CountryCode: US
TelephoneNumber: 2534414742
FaxNumber: 2534428790
Practice Location
Address1: 1202 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984053926
CountryCode: US
TelephoneNumber: 2534414742
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/23/2022
LastUpdateDate: 04/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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