Individual
GLENN OWEN SIEGFRIED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 RENNER DR, FORTUNA, CA 95540-3120
(707) 725-3361
Mailing address
PO BOX 601, BAYSIDE, CA 95524-0601
(707) 822-7743
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C42089
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C420890
—
CA
Enumeration date
04/06/2006
Last updated
10/29/2010
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