Healthcare Provider Details

I. General information

NPI: 1386790491
Provider Name (Legal Business Name): JEROME S. SIEGEL, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD SUITE 607
MEMPHIS TN
38120-2131
US

IV. Provider business mailing address

6025 WALNUT GROVE RD SUITE 607
MEMPHIS TN
38120-2131
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-2161
  • Fax: 901-681-0768
Mailing address:
  • Phone: 901-683-2161
  • Fax: 901-681-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberMD26874
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD4189
License Number StateTN

VIII. Authorized Official

Name: JEROME S SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 901-683-2161