Provider Demographics
NPI:1386790491
Name:JEROME S. SIEGEL, M.D. P.C.
Entity type:Organization
Organization Name:JEROME S. SIEGEL, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-683-2161
Mailing Address - Street 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 607
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-683-2161
Mailing Address - Fax:901-681-0768
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 607
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-683-2161
Practice Address - Fax:901-681-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26874207RA0000X
TNMD4189207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370337Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER