Provider Demographics
NPI:1962407791
Name:SIEVERS, RICHARD E (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:SIEVERS
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:PO BOX 1000 DEPT 448
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0448
Mailing Address - Country:US
Mailing Address - Phone:901-682-1100
Mailing Address - Fax:901-682-6915
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 624B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5221
Practice Address - Country:US
Practice Address - Phone:901-682-1100
Practice Address - Fax:901-682-6915
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13632207W00000X, 207WX0107X
ARN7179207W00000X, 207WX0107X
MS15012207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M128OtherBLUE CROSS OF ARKANSAS
TN180030599OtherRAILROAD MEDICARE
TN3011132Medicaid
ARP00777025OtherRAILROAD MEDICARE
MS00119412Medicaid
MO202044103Medicaid
TN0053763OtherBLUE CROSS OF TENNESSEE
AR107479001Medicaid
TN180030599OtherRAILROAD MEDICARE
TNA97534Medicare UPIN
TN0053763OtherBLUE CROSS OF TENNESSEE