Provider Demographics
NPI:1093760175
Name:SEIBEL, JOHN EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:SEIBEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2153 DEPT 1882
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-1882
Mailing Address - Country:US
Mailing Address - Phone:662-227-9991
Mailing Address - Fax:662-227-9996
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:STE W
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901
Practice Address - Country:US
Practice Address - Phone:901-767-3123
Practice Address - Fax:901-767-3884
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS15354207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03487Medicare PIN
MSF40757Medicare UPIN