1174545669 NPI number — JAY J SEYMOUR MD

Table of content: JAY J SEYMOUR MD (NPI 1174545669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174545669 NPI number — JAY J SEYMOUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEYMOUR
Provider First Name:
JAY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174545669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 BLANCHARD CIR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60187-2039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-510-9009
Provider Business Mailing Address Fax Number:
630-510-0152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 BLANCHARD CIR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60187-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-510-9009
Provider Business Practice Location Address Fax Number:
630-510-0152
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036094246 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0222075 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036094264 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363149833 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3631498336019001 . This is a "CDPG HFS PAYEE ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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