Provider Demographics
NPI:1043716624
Name:RIBBECK, PHILLIP BUCKLEY (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BUCKLEY
Last Name:RIBBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BUCKY
Other - Middle Name:
Other - Last Name:RIBBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5118 POMEGRANATE PATH
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15400 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3877
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4072080S0010X
TXT1533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine