Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4244 | GA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME124350 | FL |
NPI | 1215248711 |
---|---|
Provider Name | Evan Matthew Siegall |
First Address | Rockland, DE 19732-0191 |
Second Address | Savannah, GA 31405-3662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 31/05/2019 |