Basic Information
| Provider Information | |||||||||
| NPI: | 1962819276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIEMON | ||||||||
| FirstName: | JOHN | ||||||||
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| NameSuffix: | III | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 NW 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052431475 | ||||||||
| FaxNumber: | 3052434938 | ||||||||
| Practice Location | |||||||||
| Address1: | 12741 MIRAMAR PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330272905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546029723 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2014 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME137033 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | TRN20748 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207VX0201X | ME137033 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.