Provider Demographics
NPI:1598907149
Name:SIOMOS, VASSILIS JERRY (MD)
Entity Type:Individual
Prefix:
First Name:VASSILIS
Middle Name:JERRY
Last Name:SIOMOS
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 1:350 HERITAGE WAY
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3158
Mailing Address - Country:US
Mailing Address - Phone:406-752-8456
Mailing Address - Fax:
Practice Address - Street 1:350 HERITAGE WAY STE 2300
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3167
Practice Address - Country:US
Practice Address - Phone:406-752-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT41781208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology