Provider Demographics
NPI:1467661389
Name:SIEFERT, JAMES WILLIAM
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:SIEFERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 NE 47TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2225
Mailing Address - Country:US
Mailing Address - Phone:360-513-7382
Mailing Address - Fax:
Practice Address - Street 1:907 NE 47TH AVE
Practice Address - Street 2:3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2225
Practice Address - Country:US
Practice Address - Phone:360-513-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion