Healthcare Provider Details

I. General information

NPI: 1780741306
Provider Name (Legal Business Name): JOHN VAUGHN SIEBEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 DE ANZA BLVD
SAN MATEO CA
94402-3913
US

IV. Provider business mailing address

2925 DEBARR RD 300
ANCHORAGE AK
99508-2974
US

V. Phone/Fax

Practice location:
  • Phone: 650-341-9131
  • Fax: 650-341-9135
Mailing address:
  • Phone: 907-279-3155
  • Fax: 907-257-9856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG26383
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberM-13451
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: