Provider Demographics
NPI:1689678153
Name:DIBBS, PAUL KHALED (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KHALED
Last Name:DIBBS
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:PO BOX 51742
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1742
Mailing Address - Country:US
Mailing Address - Phone:337-942-1151
Mailing Address - Fax:
Practice Address - Street 1:105 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3850
Practice Address - Country:US
Practice Address - Phone:337-942-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11220R207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1665169Medicaid
LA5W243CT09Medicare PIN
LAF65909Medicare UPIN
LA5W243Medicare PIN