Provider Demographics
NPI:1457379133
Name:SIEGFRIED, CARLA J (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:SIEGFRIED
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3937
Mailing Address - Fax:314-747-5375
Practice Address - Street 1:4901 FOREST PARK AVE FL 6
Practice Address - Street 2:6TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1402
Practice Address - Country:US
Practice Address - Phone:314-362-3937
Practice Address - Fax:314-362-3725
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-06-07
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Provider Licenses
StateLicense IDTaxonomies
MOR7N83207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207661612Medicaid
ILENROLLEDMedicaid
MO070010103Medicaid
IL$$$$$$$$$Medicaid