MEDICARE: DR. BRYAN G. SIBLEY 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	208000000X	Pediatrics Physician	MD.020522	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588662670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN G. SIBLEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 52743
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-2743
Country	:	US
Telephone Number	:	337-289-0042
Fax Number	:	337-289-0043

Provider Business Practice Location Address
First Line	:	1211 COOLIDGE BLVD
Second Line	:	SUITE 300
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2636
Country	:	US
Telephone Number	:	337-289-0042
Fax Number	:	337-289-0043

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/25/2013

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