1194824771 NPI number — DR. MICHAEL BRUCE SEAY M.D./PH.D.

Table of content: DR. MICHAEL BRUCE SEAY M.D./PH.D. (NPI 1194824771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194824771 NPI number — DR. MICHAEL BRUCE SEAY M.D./PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEAY
Provider First Name:
MICHAEL
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D./PH.D.
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:
1194824771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38130-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-369-1420
Provider Business Mailing Address Fax Number:
901-369-1433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 OAK COURT DR
Provider Second Line Business Practice Location Address:
SUITE127
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-369-1420
Provider Business Practice Location Address Fax Number:
901-729-2412
Provider Enumeration Date:
09/21/2006

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: 2084P0800X , with the licence number:  E-5200 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 38502 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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