Provider Demographics
NPI:1407128796
Name:DR. RICHARD SEELY M.D
Entity Type:Organization
Organization Name:DR. RICHARD SEELY M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-949-9001
Mailing Address - Street 1:1840 MAIN ST
Mailing Address - Street 2:#204
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3685
Mailing Address - Country:US
Mailing Address - Phone:305-949-9001
Mailing Address - Fax:305-949-9038
Practice Address - Street 1:1840 MAIN ST
Practice Address - Street 2:#204
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3685
Practice Address - Country:US
Practice Address - Phone:305-949-9001
Practice Address - Fax:305-949-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME374222084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN