Provider Demographics
NPI:1639110224
Name:SIEGEL, JONATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:SIEGEL
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 1:3601 SPRINGHILL BUSINESS PARK STE 201
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1263
Mailing Address - Country:US
Mailing Address - Phone:251-873-6192
Mailing Address - Fax:251-873-6193
Practice Address - Street 1:3601 SPRINGHILL BUSINESS PARK STE 201
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1263
Practice Address - Country:US
Practice Address - Phone:251-873-6192
Practice Address - Fax:251-891-6193
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051534478Medicaid
AL051534478OtherMEDICARE PTAN
AL051534478Medicaid