Provider Demographics
NPI:1710029665
Name:SIEWERT, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:SIEWERT
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:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-1078
Mailing Address - Country:US
Mailing Address - Phone:406-285-3251
Mailing Address - Fax:406-285-6742
Practice Address - Street 1:16 RAILWAY AVE.
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-1078
Practice Address - Country:US
Practice Address - Phone:406-285-3251
Practice Address - Fax:406-285-6742
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine