Provider Demographics
NPI:1356309264
Name:REZA DAVID SEIRAFI MD PC
Entity Type:Organization
Organization Name:REZA DAVID SEIRAFI MD PC
Other - Org Name:SEIRAFI SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEIRAFI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:205-435-0938
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 1:7201 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7101
Practice Address - Country:US
Practice Address - Phone:205-435-0938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I076Medicare PIN