Provider Demographics
NPI:1255639886
Name:RICHARD LAWRENCE SIEGEL, M.D., P.A.
Entity type:Organization
Organization Name:RICHARD LAWRENCE SIEGEL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:813-972-3131
Mailing Address - Street 1:3450 EAST FLETCHER AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4655
Mailing Address - Country:US
Mailing Address - Phone:813-972-3131
Mailing Address - Fax:613-972-0773
Practice Address - Street 1:3450 EAST FLETCHER AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4655
Practice Address - Country:US
Practice Address - Phone:813-972-3131
Practice Address - Fax:613-972-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37894207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065518000Medicaid
FL065518000Medicaid