Provider Demographics
NPI:1366495129
Name:SIEVERT, FRANK A (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:SIEVERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NW ELKS DR
Mailing Address - Street 2:ASBURY BUILDING
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3745
Mailing Address - Country:US
Mailing Address - Phone:541-754-1150
Mailing Address - Fax:
Practice Address - Street 1:601 NW HICKORY ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1752
Practice Address - Country:US
Practice Address - Phone:541-926-3441
Practice Address - Fax:541-926-1010
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002039207Q00000X
ORMD28172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR245623Medicaid
ORR 142989Medicare PIN
OR245623Medicaid