Provider Demographics
NPI:1851368153
Name:SIEMER, DEANNA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIA
Last Name:SIEMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 EAST MAIN
Mailing Address - Street 2:STE A
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-204-1400
Mailing Address - Fax:573-204-1480
Practice Address - Street 1:2685 EAST MAIN
Practice Address - Street 2:STE A
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755
Practice Address - Country:US
Practice Address - Phone:573-204-1400
Practice Address - Fax:573-204-1480
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106442207Q00000X, 207V00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO331735OtherHEALTHLINK
MO109627OtherBCBS
MO208495622Medicaid
MO331735OtherHEALTHLINK
000013775Medicare ID - Type Unspecified