Provider Demographics
NPI:1821031212
Name:SIEGAL, JEFFREY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWARD
Last Name:SIEGAL
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 1:15340 JOG RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2170
Mailing Address - Country:US
Mailing Address - Phone:561-495-8558
Mailing Address - Fax:561-495-8557
Practice Address - Street 1:15340 JOG RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2170
Practice Address - Country:US
Practice Address - Phone:561-495-8558
Practice Address - Fax:561-495-8557
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME53104207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4761580001OtherDMERC
FL4761580001OtherDMERC
FLE45963Medicare UPIN
FL4761580001Medicare NSC
FL08212Medicare PIN