Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 7114 | MD |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DTP383 | FL |
NPI | 1245235514 |
---|---|
Provider Name | Dr. Michael Alan Siegel |
First Address | Davie, FL 33328-6962 |
Second Address | Davie, FL 33328-6962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T59631 | (02) | FL |