Provider Demographics
NPI:1083935951
Name:SIEGEL, JOSEPH AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:AARON
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:REGIMENTAL AID STATION, 7TH MARINES
Mailing Address - Street 2:BUILDING 1538
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278
Mailing Address - Country:US
Mailing Address - Phone:843-364-5746
Mailing Address - Fax:
Practice Address - Street 1:3203 LUDWIG CT APT D
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-9474
Practice Address - Country:US
Practice Address - Phone:438-364-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65890208D00000X, 171000000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
337634OtherAMERICAN BOARD OF INTERNAL MEDICINE CERTIFICATION
GA65890OtherSTATE LICENSE TO PRACTICE MEDICINE