Healthcare Provider Details

I. General information

NPI: 1821031212
Provider Name (Legal Business Name): JEFFREY EDWARD SIEGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 JOG RD SUITE 210
DELRAY BEACH FL
33446-2170
US

IV. Provider business mailing address

15340 JOG RD SUITE 210
DELRAY BEACH FL
33446-2170
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-8558
  • Fax: 561-495-8557
Mailing address:
  • Phone: 561-495-8558
  • Fax: 561-495-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME53104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: