Provider Demographics
NPI:1326147828
Name:SENECAL, JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SENECAL
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 1:825 WEST WASHINGTON ST SUITE 12
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1851
Mailing Address - Country:US
Mailing Address - Phone:334-370-0821
Mailing Address - Fax:800-370-3096
Practice Address - Street 1:825 WEST WASHINGTON ST SUITE 12
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1851
Practice Address - Country:US
Practice Address - Phone:334-370-0821
Practice Address - Fax:800-370-3096
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD8821207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA184129545AMedicaid
AL515-47871OtherBCBS ALABAMA
AL1326147828Medicaid
AL515-47871OtherBCBS ALABAMA
AL510I080200Medicare PIN