Provider Demographics
NPI:1376782458
Name:SIDDALL, SEAMUS M (PA-C)
Entity Type:Individual
Prefix:
First Name:SEAMUS
Middle Name:M
Last Name:SIDDALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1643
Mailing Address - Country:US
Mailing Address - Phone:907-750-5510
Mailing Address - Fax:907-585-6244
Practice Address - Street 1:200 A STREET
Practice Address - Street 2:SIDDALL MEDICAL SERVICES AT CLEAR AFS
Practice Address - City:CLEAR AFS
Practice Address - State:AK
Practice Address - Zip Code:99704
Practice Address - Country:US
Practice Address - Phone:907-585-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKT2010207PE0004X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS1919731OtherDEA