Provider Demographics
NPI:1760531511
Name:SIEGAL, ALAN MYRON (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MYRON
Last Name:SIEGAL
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 1:840 MONTCLAIR RD
Mailing Address - Street 2:SUIGE 122
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1920
Mailing Address - Country:US
Mailing Address - Phone:205-592-5135
Mailing Address - Fax:205-592-1795
Practice Address - Street 1:840 MONTCLAIR RD
Practice Address - Street 2:SUITE 317
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1920
Practice Address - Country:US
Practice Address - Phone:205-592-1095
Practice Address - Fax:205-599-4538
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3972207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000023708Medicaid
C74098Medicare UPIN
AL000023708Medicaid