Provider Demographics
NPI:1952657736
Name:SIBLEY, WILLIE FRANK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:FRANK
Last Name:SIBLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:FRANK
Other - Last Name:SIBLEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4330 MONTEITH DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043
Mailing Address - Country:US
Mailing Address - Phone:323-296-2689
Mailing Address - Fax:323-295-0741
Practice Address - Street 1:4330 MONTEITH DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043
Practice Address - Country:US
Practice Address - Phone:323-296-2689
Practice Address - Fax:323-295-0741
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE29139208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A291390Medicaid
CA00A291390Medicaid