Healthcare Provider Details

I. General information

NPI: 1033211859
Provider Name (Legal Business Name): BRYAN G SIBLEY MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD STE 300
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

PO BOX 52743
LAFAYETTE LA
70505-2743
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-0042
  • Fax: 337-289-0043
Mailing address:
  • Phone: 337-289-0042
  • Fax: 337-289-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN G SIBLEY
Title or Position: OWNER
Credential: MD
Phone: 337-289-0042