Provider Demographics
NPI:1538103197
Name:SIEVERS, JOEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:WILLIAM
Last Name:SIEVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0055
Mailing Address - Country:US
Mailing Address - Phone:575-226-3023
Mailing Address - Fax:575-226-3024
Practice Address - Street 1:304 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6218
Practice Address - Country:US
Practice Address - Phone:575-226-3023
Practice Address - Fax:575-226-3024
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H09985Medicare UPIN