Provider Demographics
NPI:1588662670
Name:SIBLEY, BRYAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:G
Last Name:SIBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.020522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1962848Medicaid
F27301Medicare UPIN