Provider Demographics
NPI:1720253289
Name:SIEBENS, DAVID PHILLIPS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PHILLIPS
Last Name:SIEBENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 CLAYMORE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9095
Mailing Address - Country:US
Mailing Address - Phone:919-929-2848
Mailing Address - Fax:
Practice Address - Street 1:5 MOORE DRIVE
Practice Address - Street 2:GLAXOSMITHKLINE
Practice Address - City:RESEARCH TRIANGLE PARK
Practice Address - State:NC
Practice Address - Zip Code:27709-3398
Practice Address - Country:US
Practice Address - Phone:919-483-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29870207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29870OtherLICENSE NUMBER