Healthcare Provider Details

I. General information

NPI: 1841388022
Provider Name (Legal Business Name): DWIGHT WILLIAM SIEVERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 N PALM AVE STE 107
FRESNO CA
93711-5734
US

IV. Provider business mailing address

7131 N 11TH ST STE 104
FRESNO CA
93720-3375
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0800
  • Fax: 559-435-7720
Mailing address:
  • Phone: 559-435-0800
  • Fax: 559-435-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG47593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: