Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 9085 | AZ |
Y | 207R00000X | Internist | 9085 | AZ |
Y | 111NI0900X | Internist | 9085 | AZ |
N | 208D00000X | General Practice Physician | 9085 | AZ |
NPI | 1043397276 |
---|---|
Provider Name | George L Sibley |
First Address | Scottsdale, AZ 85258-4581 |
Second Address | Phoenix, AZ 85032-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 30/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
238601 | (05) | AZ |
Z184786 | MEDICARE PTAN (01) | AZ |