Provider Demographics
NPI:1497247688
Name:STREETER, SETH (DO)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:STREETER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228-8829
Mailing Address - Country:US
Mailing Address - Phone:515-994-2617
Mailing Address - Fax:515-994-2365
Practice Address - Street 1:404 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IA
Practice Address - Zip Code:50228-8829
Practice Address - Country:US
Practice Address - Phone:515-994-2617
Practice Address - Fax:515-994-2365
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine