Provider Demographics
NPI:1164634606
Name:TAQUET, SYBIL JANE (MD)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:JANE
Last Name:TAQUET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SYBIL
Other - Middle Name:JANE
Other - Last Name:TAQUET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2410 BOONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-2226
Mailing Address - Country:US
Mailing Address - Phone:979-690-4808
Mailing Address - Fax:
Practice Address - Street 1:2410 BOONVILLE RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-2226
Practice Address - Country:US
Practice Address - Phone:979-690-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2099160-01Medicaid
TX8BZ752OtherBCBS
TX8L12904Medicare PIN