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NPI Code Detail

MEDICARE: JAN K. SIEBERSMA M.D.

MEDICARE: JAN K. SIEBERSMA 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
1207VG0400XGynecology Physician92-345NM
2207V00000XObstetrics & Gynecology Physician8076AWY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NM009818OTHERNMBCBS
225802OTHERNMPRES
35275478OTHERNMLOVELACE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952303216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN K. SIEBERSMA M.D.
Provider Business Mailing Address
First Line : 745 BUENA VISTA DR
Second Line :
City : LANDER
State : WY
Zip : 82520-3431
Country : US
Telephone Number : 307-332-2941
Fax Number : 307-332-1920
Provider Business Practice Location Address
First Line : 745 BUENA VISTA DR
Second Line :
City : LANDER
State : WY
Zip : 82520-3431
Country : US
Telephone Number : 307-332-2941
Fax Number : 307-332-1920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 06/15/2015

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