Provider Demographics
NPI:1164937090
Name:SIEGEL, ALLISON RUTH (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RUTH
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CRAWFORD ST APT 725
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-2286
Mailing Address - Country:US
Mailing Address - Phone:214-680-9870
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE
Practice Address - Street 2:0426
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-745-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380589701Medicaid
TX380589702Medicaid