MEDICARE: JEFFREY SIEGEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	J5481	TX

General Provider Information

NPI Number	:	1134187560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY SIEGEL M.D.

Provider Business Mailing Address
First Line	:	1420 VICEROY DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-2208
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:	214-366-6127

Provider Business Practice Location Address
First Line	:	3601 LIVE OAK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6136
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:	214-366-6330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/28/2008

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