Provider Demographics
NPI:1033211859
Name:BRYAN G SIBLEY MD APMC
Entity Type:Organization
Organization Name:BRYAN G SIBLEY MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-289-0042
Mailing Address - Street 1:PO BOX 52743
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2743
Mailing Address - Country:US
Mailing Address - Phone:337-289-0042
Mailing Address - Fax:337-289-0043
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-289-0042
Practice Address - Fax:337-289-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1821802Medicaid