MEDICARE: DR. LLOYD DAVID BIBY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	18016	OK
2	207L00000X	Anesthesiology Physician	MD22253	OR

General Provider Information

NPI Number	:	1194722785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LLOYD DAVID BIBY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7247
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97475-0011
Country	:	US
Telephone Number	:	541-686-9551
Fax Number	:	541-687-6716

Provider Business Practice Location Address
First Line	:	3333 RIVERBEND DRIVE
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-686-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/18/2012

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