1619493038 NPI number — MR. DOUGLAS W SEIFMAN

Table of content: HEATHER HARTLEY COLLINS (NPI 1679907786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619493038 NPI number — MR. DOUGLAS W SEIFMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIFMAN
Provider First Name:
DOUGLAS
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1619493038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12200 E STATE ROUTE 69 LOT 254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEWEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86327-4523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-225-5486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PISCADERAWEG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLEMSTAD
Provider Business Practice Location Address State Name:
CURAAO
Provider Business Practice Location Address Postal Code:
04797
Provider Business Practice Location Address Country Code:
AN
Provider Business Practice Location Address Telephone Number:
599-946-3610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 867530921 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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