Provider Demographics
NPI:1851394118
Name:WYBLE, STEVE S (MD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:S
Last Name:WYBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:S
Other - Last Name:WYBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0069
Mailing Address - Country:US
Mailing Address - Phone:337-407-4512
Mailing Address - Fax:
Practice Address - Street 1:3983 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0758
Practice Address - Country:US
Practice Address - Phone:337-407-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019978207L00000X
LAMD.019978208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1389820Medicaid
LAD98117Medicare UPIN
LA1389820Medicaid
LA5J632C203Medicare PIN
LA5J632Medicare PIN