Provider Demographics
NPI:1467683565
Name:QUAM, SETH R (DO)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:R
Last Name:QUAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:101 SE DESTINATION DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-6608
Mailing Address - Country:US
Mailing Address - Phone:515-986-4524
Mailing Address - Fax:515-986-4531
Practice Address - Street 1:101 SE DESTINATION DR
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-6608
Practice Address - Country:US
Practice Address - Phone:515-986-4524
Practice Address - Fax:515-986-4531
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-8713207Q00000X
IA4116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1467683565Medicaid
IAP01137878OtherRR MEDICARE
IA719260244Medicare PIN