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General NPI Number Information
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NPI Number | 1518247881
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Entity Type | Individual
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Provider Name | JACK M SIBRIZZI DPM
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Gender | Male
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 442 E MAIN ST STE A
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City | CLAYTON
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State | NC
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Zip | 27520-2553
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Country | US
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Telephone | 919-585-6607
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Fax | 919-585-6648
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Provider Business Mailing Address
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Address Line | 118 CRICKET HOLLOW RUN
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City | CLAYTON
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State | NC
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Zip | 27520-5922
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Country | US
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Telephone | 919-320-6333
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Fax | 919-550-9387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 570
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License Number State | NC
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