Provider Demographics
NPI:1033255989
Name:SEYMOUR, KAREN J
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W CHEYENNE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLO SPRGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-2424
Mailing Address - Country:US
Mailing Address - Phone:719-632-0324
Mailing Address - Fax:719-955-2854
Practice Address - Street 1:730 W CHEYENNE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLO SPRGS
Practice Address - State:CO
Practice Address - Zip Code:80905-2424
Practice Address - Country:US
Practice Address - Phone:719-632-0324
Practice Address - Fax:719-955-2854
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO110662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26102846Medicaid
CO110662OtherLICENSE
COMS0534380OtherDEA
CO110662OtherLICENSE