1740217967 NPI number — ROBERT JAMES SETON MPT, OCS

Table of content: ROBERT JAMES SETON MPT, OCS (NPI 1740217967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740217967 NPI number — ROBERT JAMES SETON MPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SETON
Provider First Name:
ROBERT
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT, OCS
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:
1740217967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12671 US HIGHWAY 98 W
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
DESTIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32550-8300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-650-4186
Provider Business Mailing Address Fax Number:
850-650-4188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12671 HWY 98 W
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
DESTIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-650-4186
Provider Business Practice Location Address Fax Number:
850-650-4188
Provider Enumeration Date:
06/26/2006

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: 225100000X , with the licence number:  PT8664 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y906X . This is a "BCBSFL GROUP #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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