Provider Demographics
NPI:1043651672
Name:ALAN SIEGEL, MD
Entity Type:Organization
Organization Name:ALAN SIEGEL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-416-1145
Mailing Address - Street 1:2295 NW CORPORATE BLVD.
Mailing Address - Street 2:#245
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-988-0545
Mailing Address - Fax:
Practice Address - Street 1:2295 NW CORPORATE BLVD
Practice Address - Street 2:#245
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7373
Practice Address - Country:US
Practice Address - Phone:561-988-0545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INJURY TREATMENT CENTER OF SOUTH FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57372332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site