Provider Demographics
NPI:1871560144
Name:SIEVERT, PAUL ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:SIEVERT
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:PO BOX 44008
Mailing Address - Street 2:UFJP DEPT. OF MEDICINE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4203 BELFORT RD
Practice Address - Street 2:UFJP SOUTHSIDE DIGESTIVE AND LIVER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-633-0375
Practice Address - Fax:904-633-0376
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88218207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2680726-00Medicaid
GA875266679AMedicaid
FLP00081368OtherRAILROAD MEDICARE
FLI00796Medicare UPIN
FL2680726-00Medicaid