Provider Demographics
NPI:1144202086
Name:SEAL, GEORGE MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MARK
Last Name:SEAL
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 1:1401 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5183
Mailing Address - Country:US
Mailing Address - Phone:406-731-8888
Mailing Address - Fax:406-731-8876
Practice Address - Street 1:1400 29TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5315
Practice Address - Country:US
Practice Address - Phone:406-454-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11257208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340001646OtherMEDICARE RAILROAD
OH4032363OtherAETNA
OHSE0571943Medicare ID - Type Unspecified
OH340001646OtherMEDICARE RAILROAD
OHD31387Medicare UPIN
OH00548OtherPARAMOUNT
OH4032363OtherAETNA
OHSE0571943Medicare ID - Type Unspecified
OH048716OtherSELECTCARE
OH340001646OtherMEDICARE RAILROAD