MEDICARE: DENISE S 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	207R00000X	Internal Medicine Physician	MD20001	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TN0101	OTHER	TN	JOHN DEERE
2	4054870	OTHER	TN	BCBS OF TN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366480709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE S SIBLEY MD

Provider Business Mailing Address
First Line	:	403 PRINCETON RD
Second Line	:	SUITE 7
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2056
Country	:	US
Telephone Number	:	423-283-0333
Fax Number	:	423-283-0518

Provider Business Practice Location Address
First Line	:	403 PRINCETON RD
Second Line	:	SUITE 7
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2056
Country	:	US
Telephone Number	:	423-283-0333
Fax Number	:	423-283-0518

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/10/2010

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