Provider Demographics
NPI:1598753725
Name:SIEFFERT, GEORGE FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:FREDERICK
Last Name:SIEFFERT
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 1:1500 E 2ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1181
Mailing Address - Country:US
Mailing Address - Phone:775-789-7000
Mailing Address - Fax:775-789-7040
Practice Address - Street 1:1500 E 2ND STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1181
Practice Address - Country:US
Practice Address - Phone:775-789-7000
Practice Address - Fax:775-789-7040
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5079208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC5338OtherBCBS
CAXPY038360Medicaid
NVCC5338OtherANTHEM BCBS
NV002016292Medicaid
CAXPY038360Medicaid
NVCC5338OtherANTHEM BCBS
NVV02WCCGS02Medicare PIN
NVB57240Medicare UPIN