Healthcare Provider Details

I. General information

NPI: 1790896074
Provider Name (Legal Business Name): ROMAN A SIBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SAINT ROSE PKWY SUITE 320
HENDERSON NV
89052-3500
US

IV. Provider business mailing address

10624 S EASTERN AVE SUITE A-963
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-997-9833
  • Fax: 702-666-0413
Mailing address:
  • Phone: 702-997-9833
  • Fax: 702-666-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number11987
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11987
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: