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NPI Code Detail

MEDICARE: DR. DAVID LAWRENCE SISEMORE D.O.

MEDICARE: DR. DAVID LAWRENCE SISEMORE D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician20A9327CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BK021ZOTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1598739575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID LAWRENCE SISEMORE D.O.
Provider Business Mailing Address
First Line : 1820 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-3010
Country : US
Telephone Number : 916-313-8400
Fax Number : 916-444-5620
Provider Business Practice Location Address
First Line : 1820 J ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-3010
Country : US
Telephone Number : 916-313-8400
Fax Number : 916-444-5260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/09/2014

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