Provider Demographics
NPI:1043227903
Name:SIEGEL, JOSHUA B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:B
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 NW STIMPSON LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8562
Mailing Address - Country:US
Mailing Address - Phone:503-936-9995
Mailing Address - Fax:503-206-7118
Practice Address - Street 1:2307 NW STIMPSON LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8562
Practice Address - Country:US
Practice Address - Phone:503-936-9995
Practice Address - Fax:503-206-7118
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22073207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287879Medicaid
WA8313363Medicaid
ORP00075904OtherRR MEDICARE
OR287879Medicaid
WA8313363Medicaid