Provider Demographics
NPI:1265500946
Name:SEITZ DERMATOLOGY, PC
Entity Type:Organization
Organization Name:SEITZ DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-8299
Mailing Address - Street 1:2112 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3830
Mailing Address - Country:US
Mailing Address - Phone:307-635-8299
Mailing Address - Fax:
Practice Address - Street 1:2112 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3830
Practice Address - Country:US
Practice Address - Phone:307-635-8299
Practice Address - Fax:307-635-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY85282A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY131660500Medicaid
WYB42851Medicare UPIN