Healthcare Provider Details

I. General information

NPI: 1093760175
Provider Name (Legal Business Name): JOHN EDWARD SEIBEL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET DR STE W
GRENADA MS
38901
US

IV. Provider business mailing address

PO BOX 2153 DEPT 1882
BIRMINGHAM AL
35287-1882
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-3123
  • Fax: 901-767-3884
Mailing address:
  • Phone: 662-227-9991
  • Fax: 662-227-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15354
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: