Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 104233 | CO |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2759 | LA |
NPI | 1033287115 |
---|---|
Provider Name | Dr. Lonnie M Sibley JR. |
First Address | Lafayette, CO 80026-1214 |
Second Address | Boulder, CO 80305-6536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 15/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02042331 | (05) | CO |