Provider Demographics
NPI:1275533838
Name:SIERRA, LILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:A
Last Name:SIERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 W DESCHUTES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7757
Mailing Address - Country:US
Mailing Address - Phone:509-374-1962
Mailing Address - Fax:509-374-0572
Practice Address - Street 1:7301 W DESCHUTES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7757
Practice Address - Country:US
Practice Address - Phone:509-374-1962
Practice Address - Fax:509-374-0572
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000243902080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1089663Medicaid
WA1089663Medicaid