Healthcare Provider Details

I. General information

NPI: 1992029904
Provider Name (Legal Business Name): JOSHUA ADAM SIBILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PKWY STE 100
LAFAYETTE LA
70508-6984
US

IV. Provider business mailing address

5000 AMBASSADOR CAFFERY PKWY STE 100
LAFAYETTE LA
70508-6984
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-4444
  • Fax:
Mailing address:
  • Phone: 337-534-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD.205510
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number40595
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: