Healthcare Provider Details

I. General information

NPI: 1841269750
Provider Name (Legal Business Name): DAVID B SIEPMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

PO BOX 516
CORVALLIS OR
97339-0516
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-6131
  • Fax: 503-474-9854
Mailing address:
  • Phone: 541-758-5047
  • Fax: 541-758-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47854
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD25751
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: