Provider Demographics
NPI:1063520591
Name:SIBANDA, GEROLD NOEL (MD)
Entity type:Individual
Prefix:DR
First Name:GEROLD
Middle Name:NOEL
Last Name:SIBANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12366
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2366
Mailing Address - Country:US
Mailing Address - Phone:205-780-7101
Mailing Address - Fax:205-206-8338
Practice Address - Street 1:832 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1320
Practice Address - Country:US
Practice Address - Phone:205-206-8460
Practice Address - Fax:205-206-8380
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00021802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630506063Medicaid
AL51212983OtherBLUE CROSS BLUE SHIELD
AL51514660SIBOtherBLUE CROSS BLUE SHIELD
AL51514660SIBOtherBLUE CROSS BLUE SHIELD