Healthcare Provider Details

I. General information

NPI: 1518129808
Provider Name (Legal Business Name): RICHARD W SIEBER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1310 24TH AVE SOUTH
NASHVILLE TN
37212
US

V. Phone/Fax

Practice location:
  • Phone: 615-708-5658
  • Fax:
Mailing address:
  • Phone: 615-708-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC005863
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005863
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberTN686
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: