Provider Demographics
NPI:1528056868
Name:SIEGEL, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:3641 W 5TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6424
Practice Address - Country:US
Practice Address - Phone:805-985-5505
Practice Address - Fax:805-985-6095
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55171207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G551711OtherINDIVIDUAL PTAN
CAWG55171AOtherINDIVIDUAL PTAN
CAWG55171FOtherINDIVIDUAL PTAN
CAWG55171HOtherINDIVIDUAL PTAN
CA00G551713OtherINDIVIDUAL PTAN
CA00G551715OtherINDIVIDUAL PTAN
CAWG55171COtherINDIVIDUAL PTAN
CAWG55171JOtherINDIVIDUAL PTAN
CAP00611069OtherRAILROAD MEDICARE
CAWG55171DOtherINDIVIDUAL PTAN
CAWG55171EOtherINDIVIDUAL PTAN
CA00G551714OtherINDIVIDUAL PTAN
CAWG55171GOtherINDIVIDUAL PTAN
CA00G551712OtherINDIVIDUAL PTAN
PADG7458OtherRAILROAD MEDICARE GROUP PTAN
CAWG55171BOtherINDIVIDUAL PTAN
CA00G551710OtherINDIVIDUAL PTAN
CAWG55171IOtherINDIVIDUAL PTAN
CAWG55171DOtherINDIVIDUAL PTAN
CAWG55171BOtherINDIVIDUAL PTAN
CAWG55171COtherINDIVIDUAL PTAN