Provider Demographics
NPI:1598868911
Name:SIERRA, RUBEN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:DANIEL
Last Name:SIERRA
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 1:7350 W DESCHUTES AVE
Mailing Address - Street 2:SUITE B103
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-783-0144
Mailing Address - Fax:509-783-8244
Practice Address - Street 1:7350 W DESCHUTES AVE
Practice Address - Street 2:SUITE B103
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-783-0144
Practice Address - Fax:509-783-8244
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024391207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8237984Medicaid
WAA806787Medicare ID - Type Unspecified
WA8237984Medicaid