Provider Demographics
NPI:1386681492
Name:SIEBER, JOHN W II (PA/AA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SIEBER
Suffix:II
Gender:M
Credentials:PA/AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HALF PENNY CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2706
Mailing Address - Country:US
Mailing Address - Phone:912-346-2316
Mailing Address - Fax:
Practice Address - Street 1:18 HALF PENNY CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-2706
Practice Address - Country:US
Practice Address - Phone:912-346-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003189367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000211EMedicaid
GAP00392013OtherRAILROAD MEDICARE
GA$$$$$$$$$OtherTRICARE
GAP00392013OtherRAILROAD MEDICARE
GAS89459Medicare UPIN