Provider Demographics
NPI:1598742447
Name:SIEGER, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SIEGER
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 1:77 W UNDERWOOD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1122
Mailing Address - Country:US
Mailing Address - Phone:321-841-7750
Mailing Address - Fax:321-841-6180
Practice Address - Street 1:77 W UNDERWOOD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1122
Practice Address - Country:US
Practice Address - Phone:321-841-7750
Practice Address - Fax:321-841-6180
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24562207R00000X
FLME0024562207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055468500Medicaid
FL055468500Medicaid
FL48848WMedicare PIN
FL48848XMedicare PIN