Active NPI
Buddy Roger Siebenlist, M.D.
- Diagnostic Radiology Physician
- Waskom, TX
National Provider Identifier
1851622393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- H4076
- Practice address
- 757 Bellview Rd
Waskom, TX 75692-3425 - Phone
- (903) 935-2800
- NPI assigned
- Jan 22, 2010
- Last updated
- Oct 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | H4076 | TX | Primary |
| Diagnostic Radiology Physician | 2085R0202X | 010260 | LA |
Addresses
Primary practice location
757 Bellview Rd
Waskom, TX 75692-3425
Mailing address
PO Box 1857
Waskom, TX 75692-1857
Phone (903) 935-2800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010260 | LA | MD | Diagnostic Radiology Physician |
| H4076 | TX | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319328000000",
"number": "1851622393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1857",
"city": "WASKOM",
"state": "TX",
"postal_code": "756921857",
"telephone_number": "903-935-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "757 BELLVIEW RD",
"city": "WASKOM",
"state": "TX",
"postal_code": "756923425",
"telephone_number": "903-935-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEBENLIST",
"first_name": "BUDDY",
"middle_name": "ROGER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-22",
"last_updated": "2011-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TX",
"license": "H4076",
"primary": true
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "LA",
"license": "010260",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waskom, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.