Provider Demographics
NPI:1073647533
Name:JAMES R SIEFER DO PLC
Entity Type:Organization
Organization Name:JAMES R SIEFER DO PLC
Other - Org Name:SIEFER UROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-985-1093
Mailing Address - Street 1:485 S DOBSON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5602
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-985-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG4079OtherRAIL ROAD