Provider Demographics
NPI:1639190770
Name:SIECK, KEVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:SIECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3023 PERRYTON PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2821
Mailing Address - Country:US
Mailing Address - Phone:806-665-0801
Mailing Address - Fax:806-665-8503
Practice Address - Street 1:3023 PERRYTON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2821
Practice Address - Country:US
Practice Address - Phone:806-665-0801
Practice Address - Fax:806-665-8503
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4200207R00000X
OK21716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G3440OtherBCBS
TX110241972OtherRAIL ROAD MEDICARE
TXL4200OtherWORKERS COMP
TX1186100001OtherDMERC CIGNA
TX132180100OtherSOUTHWEST LIFE & HEALTH
TX1186100001OtherPALMETTO DMERC
TX151473901Medicaid
TX132180100OtherFIRST CARE
TXL4200OtherUNICARE
TX151473901Medicaid
TXH62456Medicare UPIN