Myles Cox Sibley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60905204 Issued in WA

Practice address

377 Sylvan Lake Rd Ste 210
Eagle, CO 81631-6779

Phone

(970) 926-6340

Fax

(970) 926-6348

NPI assigned

Sep 6, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1619495033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4330",
            "city": "AVON",
            "state": "CO",
            "postal_code": "816204330",
            "telephone_number": "970-926-6340",
            "fax_number": "970-926-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 SYLVAN LAKE RD STE 210",
            "city": "EAGLE",
            "state": "CO",
            "postal_code": "816316779",
            "telephone_number": "970-926-6340",
            "fax_number": "970-926-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIBLEY",
        "first_name": "MYLES",
        "middle_name": "COX",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-06",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006348",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60905204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619495033",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Eagle, CO
• Providers in Eagle, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.