Provider Demographics
NPI:1891985081
Name:AYALLOORE, SIBY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SIBY
Middle Name:GEORGE
Last Name:AYALLOORE
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 1:1233 WAYNE GILMORE CIR STE 450
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6405
Mailing Address - Country:US
Mailing Address - Phone:337-942-3006
Mailing Address - Fax:337-942-7744
Practice Address - Street 1:1233 WAYNE GILMORE CIR STE 450
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-3006
Practice Address - Fax:337-942-7744
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203045207RC0000X
TXP4544207RC0000X
LA203045207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01035899Medicaid
LA1077160Medicaid
LA333665YJQDMedicare PIN
LA1077160Medicaid
LA4M0497061Medicare PIN