Provider Demographics
NPI:1013175538
Name:SIBSON, RICHARD W (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:SIBSON
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 1:421 E CENTRAL BLVD
Mailing Address - Street 2:#1304
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1654
Mailing Address - Country:US
Mailing Address - Phone:202-230-7955
Mailing Address - Fax:888-274-9026
Practice Address - Street 1:421 E CENTRAL BLVD
Practice Address - Street 2:#1304
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1654
Practice Address - Country:US
Practice Address - Phone:202-230-7955
Practice Address - Fax:888-274-9026
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5076208100000X
FLOS10707208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ339377Medicaid
AZP00625185OtherRAILROAD MEDICARE
AZZ122366Medicare PIN
FLCS226ZMedicare PIN