Provider Demographics
NPI:1760741789
Name:SIEGEL, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
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 1:120 SILVERTREE XING
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7416
Mailing Address - Country:US
Mailing Address - Phone:714-794-4878
Mailing Address - Fax:
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-226-3610
Practice Address - Fax:901-226-3612
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24498207R00000X
ARE-14097207R00000X
TN59141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine