Provider Demographics
NPI:1801048814
Name:SIEGEL, FREDRIC A (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:A
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 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3436
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9260 W SUNSET RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-534-5464
Practice Address - Fax:702-534-5465
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3127207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500484 GROUPMedicaid
NV1801048814Medicaid
NV1801048814Medicaid
NV100500484 GROUPMedicaid