Provider Demographics
NPI:1629253885
Name:JEFFREY E SIEGAL M D P A
Entity Type:Organization
Organization Name:JEFFREY E SIEGAL M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-8558
Mailing Address - Street 1:15340 JOG RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2170
Mailing Address - Country:US
Mailing Address - Phone:561-495-8558
Mailing Address - Fax:561-495-8557
Practice Address - Street 1:15340 JOG RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2170
Practice Address - Country:US
Practice Address - Phone:561-495-8558
Practice Address - Fax:561-495-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 53104207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4761580001Medicare NSC
FL08212Medicare PIN
FLE45963Medicare UPIN