MEDICARE: DR. STEVEN ERIC SIEGAL M.D.

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
1	174400000X	Specialist	ME90725	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871598573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ERIC SIEGAL M.D.

Provider Business Mailing Address
First Line	:	1101 B GALE WILSON BLVD
Second Line	:	SUITE 101C
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3700
Country	:	US
Telephone Number	:	707-646-4644
Fax Number	:	707-646-4645

Provider Business Practice Location Address
First Line	:	1101 B GALE WILSON BLVD
Second Line	:	SUITE 101C
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3700
Country	:	US
Telephone Number	:	707-646-4644
Fax Number	:	707-646-4645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/16/2015

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