Provider Demographics
NPI:1962595082
Name:SIGGARD, KIPLEY J (MD)
Entity type:Individual
Prefix:
First Name:KIPLEY
Middle Name:J
Last Name:SIGGARD
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 1:275 SE CABOT DR STE B101
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3740
Mailing Address - Country:US
Mailing Address - Phone:360-678-4424
Mailing Address - Fax:360-678-5161
Practice Address - Street 1:80 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-9500
Practice Address - Country:US
Practice Address - Phone:360-678-4424
Practice Address - Fax:360-678-5161
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8176A207X00000X
UT1733941205207X00000X
WAMD60548172207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0900237OtherUNITED HEALTHCARE
190279700OtherOWCP
WY1962595082Medicaid
E27789Medicare UPIN
000004676Medicare ID - Type Unspecified
190279700OtherOWCP
0900237OtherUNITED HEALTHCARE