Provider Demographics
NPI:1992719124
Name:SEIBEL, BARRY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:SCOTT
Last Name:SEIBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11620 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 711
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1706
Mailing Address - Country:US
Mailing Address - Phone:310-444-1134
Mailing Address - Fax:310-444-1130
Practice Address - Street 1:11620 WILSHIRE BLVD
Practice Address - Street 2:SUITE 711
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1706
Practice Address - Country:US
Practice Address - Phone:310-444-1134
Practice Address - Fax:310-444-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA42981207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE07189Medicare UPIN
CAA42981Medicare ID - Type Unspecified