Provider Demographics
NPI:1376584136
Name:SEALE, STUART ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:ALLAN
Last Name:SEALE
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:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86339-0431
Mailing Address - Country:US
Mailing Address - Phone:928-274-4415
Mailing Address - Fax:
Practice Address - Street 1:135 THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5152
Practice Address - Country:US
Practice Address - Phone:928-274-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34572207Q00000X
MO36209207Q00000X
OK24223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248508816Medicare ID - Type Unspecified
MOA11302Medicare UPIN
MO000004866Medicare ID - Type Unspecified