Provider Demographics
NPI:1346239225
Name:RIFE, SEYMOUR G (MD)
Entity Type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:G
Last Name:RIFE
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 1:1125 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5045
Mailing Address - Country:US
Mailing Address - Phone:480-545-8119
Mailing Address - Fax:480-892-6805
Practice Address - Street 1:1125 E SOUTHERN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5045
Practice Address - Country:US
Practice Address - Phone:480-545-8119
Practice Address - Fax:480-892-6805
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ105862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ248345Medicaid
WCKJY14Medicare ID - Type UnspecifiedEVDI
AZ248345Medicaid
E28399Medicare UPIN
30WCFCQ16Medicare ID - Type UnspecifiedARL