Provider Demographics
NPI:1841280856
Name:SIECKMANN, PAUL W (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:SIECKMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10210 N 92ND ST
Mailing Address - Street 2:STE #106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4509
Mailing Address - Country:US
Mailing Address - Phone:480-661-1755
Mailing Address - Fax:480-661-9636
Practice Address - Street 1:10210 N 92ND ST
Practice Address - Street 2:STE #106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4509
Practice Address - Country:US
Practice Address - Phone:480-661-1755
Practice Address - Fax:480-661-9636
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ19795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD19795Medicare ID - Type Unspecified
AZE85953Medicare UPIN