Provider Demographics
NPI:1679518195
Name:SIBIA, SIRTAZ SINGH (DO)
Entity Type:Individual
Prefix:
First Name:SIRTAZ
Middle Name:SINGH
Last Name:SIBIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11195 S JOG RD
Mailing Address - Street 2:SUITE 1&2
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1829
Mailing Address - Country:US
Mailing Address - Phone:561-752-0075
Mailing Address - Fax:561-536-4200
Practice Address - Street 1:11195 S JOG RD
Practice Address - Street 2:SUITE 1&2
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1829
Practice Address - Country:US
Practice Address - Phone:561-752-0075
Practice Address - Fax:561-536-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7844207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49882OtherBCBS
FLE2719XMedicare ID - Type Unspecified
FLE2719WMedicare ID - Type Unspecified
FL49882OtherBCBS