MEDICARE: DR. STEVE S WYBLE 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	019978	LA
2	208VP0014X	Interventional Pain Medicine Physician	MD.019978	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	:	1851394118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE S WYBLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70571-0069
Country	:	US
Telephone Number	:	337-407-4512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3983 I 49 S SERVICE RD
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-0758
Country	:	US
Telephone Number	:	337-407-4512
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/10/2011

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