Provider Demographics
NPI:1174571517
Name:BIBBY, CHARLES KING (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KING
Last Name:BIBBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CREST DR
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:CO
Mailing Address - Zip Code:81220-9503
Mailing Address - Country:US
Mailing Address - Phone:970-314-1303
Mailing Address - Fax:970-314-1303
Practice Address - Street 1:180 CREST DR
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:CO
Practice Address - Zip Code:81220-9503
Practice Address - Country:US
Practice Address - Phone:970-314-1303
Practice Address - Fax:970-314-1303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35924207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35924OtherMEDICAL LICENSE #
ARPO1223844OtherRAILROAD MCARE
AR145072001Medicaid
CO65673336Medicaid
AR145072001Medicaid