Individual
LUCAS SEIBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2409 N PATTERSON ST STE 310, VALDOSTA, GA 31602-2512
(229) 433-8160
(229) 244-2707
Mailing address
2409 N PATTERSON ST STE 310, VALDOSTA, GA 31602-2512
(229) 433-8160
(229) 244-2707
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
54189
AZ
207R00000X
Internal Medicine Physician
R74418
AZ
207RC0000X
Cardiovascular Disease Physician
01083408A
IN
207RI0011X
Interventional Cardiology Physician
Primary
88599
GA
207UN0901X
Nuclear Cardiology Physician
252293
AZ
2471C3401X
Computed Tomography Radiologic Technologist
252293
AZ
Other
Enumeration date
05/05/2014
Last updated
10/26/2022
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