Individual
JOHN BARRY SIEBENLIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1551 BISHOP ST, SUITE 220, SAN LUIS OBISPO, CA 93401-4635
(805) 541-0668
(805) 541-8213
Mailing address
2285 CORPORATE CIR, STE 200, HENDERSON, NV 89074-7759
(702) 360-2763
(949) 783-2880
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
A61826
CA
207NS0135X
Procedural Dermatology Physician
Primary
A61826
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00146047
RAILROAD MEDICARE
CA
Enumeration date
05/19/2006
Last updated
03/16/2016
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