Provider Demographics
NPI:1770501868
Name:SIBIA, ROOPTAZ (MD)
Entity Type:Individual
Prefix:
First Name:ROOPTAZ
Middle Name:
Last Name:SIBIA
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 1:10075 JOG RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3535
Mailing Address - Country:US
Mailing Address - Phone:561-736-8600
Mailing Address - Fax:561-736-7191
Practice Address - Street 1:10075 JOG RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-736-8600
Practice Address - Fax:561-736-7191
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 77641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU9921ZMedicare ID - Type Unspecified
FLH28682Medicare UPIN