Provider Demographics
NPI:1073753448
Name:SEELY, JEREMIAH BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:BRENT
Last Name:SEELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-580-1584
Practice Address - Street 1:1323 E. FRANKLIN ST.
Practice Address - Street 2:SUITE 105
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645
Practice Address - Country:US
Practice Address - Phone:254-582-7481
Practice Address - Fax:254-580-1584
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM8984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200865802Medicaid
TX8L15623Medicare PIN