Provider Demographics
NPI:1497824601
Name:SIEBERT, CHARLES WILLIAM JR (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:SIEBERT
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 SATURN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2807
Mailing Address - Country:US
Mailing Address - Phone:972-278-2145
Mailing Address - Fax:972-278-0294
Practice Address - Street 1:2829 SATURN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-2807
Practice Address - Country:US
Practice Address - Phone:972-278-2145
Practice Address - Fax:972-278-0294
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0570213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T15902Medicare UPIN
TX00AM82Medicare ID - Type Unspecified