Provider Demographics
NPI:1306832761
Name:SIEGLER, ROLAND E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:E
Last Name:SIEGLER
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 1:3215 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2006
Mailing Address - Country:US
Mailing Address - Phone:817-468-1818
Mailing Address - Fax:817-468-4775
Practice Address - Street 1:3215 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2006
Practice Address - Country:US
Practice Address - Phone:817-468-1818
Practice Address - Fax:817-468-4775
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB26452Medicare UPIN
TX00KN02Medicare ID - Type Unspecified