Basic Information
| Provider Information | |||||||||
| NPI: | 1235139973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEBBE | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7332 OFFICE PARK PL | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329408241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214359800 | ||||||||
| FaxNumber: | 3214359803 | ||||||||
| Practice Location | |||||||||
| Address1: | 7332 OFFICE PARK PL | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329408241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214359800 | ||||||||
| FaxNumber: | 3214359803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 03/30/2009 | ||||||||
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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 | 208000000X | ME75303 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.