Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 26366 | AZ |
NPI | 1255544987 |
---|---|
Provider Name | Jeffrey Siegel |
First Address | Scottsdale, AZ 85258-4535 |
Second Address | Scottsdale, AZ 85258-4535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |