Individual
JACK SIEBENALER II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
207Q00000X
Family Medicine Physician
Primary
35053850
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0636539
—
OH
Enumeration date
02/27/2006
Last updated
02/13/2012
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