Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 5076 | AZ |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | OS10707 | FL |
NPI | 1013175538 |
---|---|
Provider Name | Dr. Richard W Sibson |
First Address | Orlando, FL 32801-1654 |
Second Address | Orlando, FL 32801-1654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339377 | (05) | AZ |
P00625185 | RAILROAD MEDICARE (01) | AZ |