Provider Demographics
NPI:1871649368
Name:SIEMER, MARK A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SIEMER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:13445 VOYAGER PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7648
Mailing Address - Country:US
Mailing Address - Phone:719-365-3220
Mailing Address - Fax:719-365-7681
Practice Address - Street 1:13445 VOYAGER PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7648
Practice Address - Country:US
Practice Address - Phone:719-365-3220
Practice Address - Fax:719-365-7681
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2022-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-00115207Q00000X
CO34732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841609028OtherTIN