MEDICARE: CHARLES ALLAN SIBLEY MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	T2983	TX
3	207L00000X	Anesthesiology Physician	0101252987	VA
4	207L00000X	Anesthesiology Physician	76183	GA
5	208D00000X	General Practice Physician	0101252987	VA

General Provider Information

NPI Number	:	1356649206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ALLAN SIBLEY MD

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:	DEPT OF ANESTHESIA
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-5741
Country	:	US
Telephone Number	:	210-723-9750
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:	DEPT OF ANESTHESIA
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-7823
Country	:	US
Telephone Number	:	210-723-9750
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	05/24/2023

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Directions to “ CHARLES ALLAN SIBLEY MD” Practice Location

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