Provider Demographics
NPI:1972509214
Name:DWIGHT W SIEVERT MD INC
Entity Type:Organization
Organization Name:DWIGHT W SIEVERT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SYUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-435-0800
Mailing Address - Street 1:7766 N PALM AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5734
Mailing Address - Country:US
Mailing Address - Phone:559-435-0800
Mailing Address - Fax:559-435-7720
Practice Address - Street 1:7766 N PALM AVE STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5734
Practice Address - Country:US
Practice Address - Phone:559-435-0800
Practice Address - Fax:559-435-7720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DWIGHT W SIEVERT MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-22
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG475932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G47593Medicare ID - Type Unspecified
A50750Medicare UPIN
CAA50750Medicare UPIN