Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD60584255 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD60584255 | WA |
NPI | 1174866354 |
---|---|
Provider Name | David Mason Siebert |
First Address | Seattle, WA 98195 |
Second Address | Seattle, WA 98195-8021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 07/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174866354 | (05) | WA |