Provider Demographics
NPI:1780741306
Name:SIEBEL, JOHN VAUGHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VAUGHN
Last Name:SIEBEL
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 1:2925 DEBARR RD 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2974
Mailing Address - Country:US
Mailing Address - Phone:907-279-3155
Mailing Address - Fax:907-257-9856
Practice Address - Street 1:218 DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3913
Practice Address - Country:US
Practice Address - Phone:650-341-9131
Practice Address - Fax:650-341-9135
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26383207RH0003X
IDM-13451207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G263830Medicare ID - Type Unspecified
CAA42993Medicare UPIN