Organization
JACK SIEBENALER II MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK G SIEBENALER II MD (OWNER)
(419) 691-0636
Entity
Organization
Contact information
Practice address
3232 NAVARRE AVE, OREGON, OH 43616-3312
(419) 691-0636
(419) 693-1412
Mailing address
3232 NAVARRE AVE, OREGON, OH 43616-3312
(419) 691-0636
(419) 693-1412
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
350535801S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056057
—
OH
Enumeration date
12/06/2007
Last updated
02/22/2012
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