Provider Demographics
NPI:1750327979
Name:STIBOR, NOEL B (MD)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:B
Last Name:STIBOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P.O. BOX 579
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0579
Mailing Address - Country:US
Mailing Address - Phone:307-885-5852
Mailing Address - Fax:307-885-5889
Practice Address - Street 1:110 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0579
Practice Address - Country:US
Practice Address - Phone:307-885-5852
Practice Address - Fax:307-885-5889
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY4014A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104948800Medicaid
WYA73176Medicare UPIN