Provider Demographics
NPI:1023009180
Name:SEIBEL, DAVID G (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:SEIBEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9215
Mailing Address - Country:US
Mailing Address - Phone:541-673-7615
Mailing Address - Fax:
Practice Address - Street 1:2028 FISHER RD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-9215
Practice Address - Country:US
Practice Address - Phone:541-673-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO165202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR007695Medicaid
E67818Medicare UPIN
00WCGFTFMedicare ID - Type Unspecified
R00WCGFTFMedicare PIN