Provider Demographics
NPI:1184680431
Name:SEIRAFI, TRUDIE DIANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:TRUDIE
Middle Name:DIANNE
Last Name:SEIRAFI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:TRUDIE
Other - Middle Name:DIANNE
Other - Last Name:BOGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 240635
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0635
Mailing Address - Country:US
Mailing Address - Phone:205-435-0938
Mailing Address - Fax:
Practice Address - Street 1:1510 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1517
Practice Address - Country:US
Practice Address - Phone:334-834-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-201363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58192Medicare UPIN