Provider Demographics
NPI:1003055245
Name:SEYMOUR, STEPHEN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1482 US HIGHWAY 395 N
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5208
Mailing Address - Country:US
Mailing Address - Phone:775-783-1122
Mailing Address - Fax:775-783-0868
Practice Address - Street 1:1482 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5208
Practice Address - Country:US
Practice Address - Phone:775-783-1122
Practice Address - Fax:775-783-0868
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0509213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT19215Medicare UPIN