Individual
DR. JEROME SEYMOUR SIEGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1714 W MASSEY RD, MEMPHIS, TN 38120-4205
(901) 685-5520
(901) 685-0782
Mailing address
1714 W MASSEY RD, MEMPHIS, TN 38120-4205
(901) 685-5520
(901) 685-0782
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD0000004189
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110092173
RAILROD MEDICARE
TN
01
—
4159151
BLUE CROSS OF TENNESSEE
TN
01
—
62-1792869
TAX IDENTIFICATION #
TN
01
—
P00465587
RR MEDICARE
TN
Enumeration date
05/06/2006
Last updated
09/27/2016
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