Provider Demographics
NPI:1043359383
Name:BRIAN SIEGEL, MD, PC
Entity Type:Organization
Organization Name:BRIAN SIEGEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-422-7991
Mailing Address - Street 1:PO BOX 701075
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270-0001
Mailing Address - Country:US
Mailing Address - Phone:303-422-7991
Mailing Address - Fax:303-422-7994
Practice Address - Street 1:1024 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8813
Practice Address - Country:US
Practice Address - Phone:303-422-7991
Practice Address - Fax:303-422-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02179253Medicaid
CO02179253Medicaid