Provider Demographics
NPI:1700846607
Name:SIGMUND, STEPHEN TRACY (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:TRACY
Last Name:SIGMUND
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:P.O BOX 1267
Mailing Address - Street 2:1310 LAS TABLAS, SUITE 102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465
Mailing Address - Country:US
Mailing Address - Phone:805-434-0729
Mailing Address - Fax:805-434-2535
Practice Address - Street 1:1310 LAS TABLAS, SUITE 102
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465
Practice Address - Country:US
Practice Address - Phone:805-434-0729
Practice Address - Fax:805-434-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1506235OtherMULTIPLAN
1506235OtherMULTIPLAN
CAF57118Medicare UPIN
WG724400DMedicare PIN