Provider Demographics
NPI:1528068640
Name:SIEMS, JON L (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:L
Last Name:SIEMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6227
Mailing Address - Country:US
Mailing Address - Phone:702-948-2010
Mailing Address - Fax:702-920-8787
Practice Address - Street 1:3810 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6227
Practice Address - Country:US
Practice Address - Phone:702-948-2010
Practice Address - Fax:702-920-8787
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9250174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018998Medicaid
NV2018998Medicaid
NVG12558Medicare UPIN