Provider Demographics
NPI:1043278161
Name:SEITZ, THOMAS LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEE
Last Name:SEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12550 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-768-2111
Mailing Address - Fax:239-482-4404
Practice Address - Street 1:650 DEL PRADO BOULEVARD
Practice Address - Street 2:SUITE 103
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-768-2111
Practice Address - Fax:239-458-2324
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME47666208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046937800Medicaid
FL2981Medicare ID - Type Unspecified
FLD20813Medicare UPIN