Provider Demographics
NPI:1275611592
Name:SIEGEL, BRUCE FREDERICK (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FREDERICK
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7781 COOPER ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7728
Mailing Address - Country:US
Mailing Address - Phone:513-871-8020
Mailing Address - Fax:513-891-6385
Practice Address - Street 1:7781 COOPER ROAD
Practice Address - Street 2:BRUCE F SIEGEL DO
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-871-8020
Practice Address - Fax:513-891-6385
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004419208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0684522Medicaid
OHSI0609771Medicare ID - Type Unspecified
OH0684522Medicaid