Provider Demographics
NPI:1770518938
Name:SIEGEL, RICHARD LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:SIEGEL
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 1:17407 BRIDGE HILL CT STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3522
Mailing Address - Country:US
Mailing Address - Phone:813-972-3131
Mailing Address - Fax:813-972-0773
Practice Address - Street 1:17407 BRIDGE HILL CT STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3522
Practice Address - Country:US
Practice Address - Phone:813-972-3131
Practice Address - Fax:813-972-0773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37984207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065518000Medicaid
FL065518000Medicaid
FL30376Medicare ID - Type Unspecified