Provider Demographics
NPI:1124371927
Name:DAVID C. SEELEY, MD PC
Entity Type:Organization
Organization Name:DAVID C. SEELEY, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-439-8909
Mailing Address - Street 1:5422 W THUNDERBIRD RD
Mailing Address - Street 2:STE 15
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4700
Mailing Address - Country:US
Mailing Address - Phone:602-439-8909
Mailing Address - Fax:602-547-3013
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:STE 15
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4700
Practice Address - Country:US
Practice Address - Phone:602-439-8909
Practice Address - Fax:602-547-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C93740Medicare PIN