Individual
DR. ERIK DAVID SIBBERNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3101 E STATE ST STE 2120, EAGLE, ID 83616-6232
(208) 473-3275
(208) 473-3276
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 813-8752
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
01075639A
IN
207R00000X
Internal Medicine Physician
Primary
M-17816
ID
390200000X
Student in an Organized Health Care Education/Training Program
PG168052
OR
Other
Enumeration date
05/02/2014
Last updated
08/08/2024
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