Provider Demographics
NPI:1437491743
Name:JERRAL S SEIBERT M D INC
Entity Type:Organization
Organization Name:JERRAL S SEIBERT M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-939-1220
Mailing Address - Street 1:3685 NORDSTROM LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3027
Mailing Address - Country:US
Mailing Address - Phone:925-939-1220
Mailing Address - Fax:925-283-4123
Practice Address - Street 1:1220 ROSSMOOR PKWY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2501
Practice Address - Country:US
Practice Address - Phone:925-484-1395
Practice Address - Fax:925-924-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17834207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A178340OtherBLUE SHIELD
CAA21081Medicare UPIN
CA00A178340Medicare PIN