Provider Demographics
NPI:1093820748
Name:SEITZ, CONRAD THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:THEODORE
Last Name:SEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 JENSEN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:96357
Mailing Address - Country:US
Mailing Address - Phone:559-875-3428
Mailing Address - Fax:559-875-3434
Practice Address - Street 1:2570 JENSEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2269
Practice Address - Country:US
Practice Address - Phone:559-875-3428
Practice Address - Fax:559-875-3434
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine