Provider Demographics
NPI:1407083884
Name:GENESIS OBGYN PA
Entity Type:Organization
Organization Name:GENESIS OBGYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-362-6435
Mailing Address - Street 1:1025 BEAL PKWY NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1446
Mailing Address - Country:US
Mailing Address - Phone:850-362-6435
Mailing Address - Fax:850-362-6777
Practice Address - Street 1:1025 BEAL PKWY NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1446
Practice Address - Country:US
Practice Address - Phone:850-362-6435
Practice Address - Fax:850-362-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98995207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty