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General NPI Number Information
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NPI Number | 1851394118
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Entity Type | Individual
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Provider Name | STEVE S WYBLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 3983 I 49 S SERVICE RD
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City | OPELOUSAS
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State | LA
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Zip | 70570-0758
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Country | US
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Telephone | 337-407-4512
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | OPELOUSAS
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State | LA
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Zip | 70571-0069
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Country | US
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Telephone | 337-407-4512
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 019978
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD.019978
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License Number State | LA
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