Provider Demographics
NPI:1467452854
Name:SIEGEL, GARY LEWIS (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEWIS
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1746 COLE BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3208
Mailing Address - Country:US
Mailing Address - Phone:303-234-1067
Mailing Address - Fax:303-232-2967
Practice Address - Street 1:1746 COLE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3208
Practice Address - Country:US
Practice Address - Phone:303-234-1067
Practice Address - Fax:303-232-2967
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO16503207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01165034Medicaid
E23312Medicare UPIN
CO01165034Medicaid