Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2-2261 | TX |
Y | 103TC0700X | Clinical Psychologist | 2-2261 | TX |
NPI | 1013038793 |
---|---|
Provider Name | Dr. Jeffrey Craig Siegel |
First Address | Dallas, TX 75230-1525 |
Second Address | Dallas, TX 75230-1525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |