Healthcare Provider Details

I. General information

NPI: 1841342763
Provider Name (Legal Business Name): ROBERT BARRY SIEGEL AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W GRANADA BLVD
ORMOND BEACH FL
32174-8154
US

IV. Provider business mailing address

1111 HANSBERRY CT
ORMOND BEACH FL
32174-1014
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-2366
  • Fax: 386-671-0342
Mailing address:
  • Phone: 386-236-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number130
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1096
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number483
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY1096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: