Provider Demographics
NPI:1528224144
Name:SEELHOEFER, GREGORY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:SEELHOEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 CENTERFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6044
Mailing Address - Country:US
Mailing Address - Phone:281-737-0902
Mailing Address - Fax:281-737-0926
Practice Address - Street 1:13802 CENTERFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6044
Practice Address - Country:US
Practice Address - Phone:281-737-0902
Practice Address - Fax:281-737-0926
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6646207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214907203Medicaid
616771105OtherUS DEPT OF LABOR
TX214907202Medicaid
601771109OtherUS DEPT OF LABOR
616771101OtherUS DEPT OF LABOR
TX8DY913OtherBLUE CROSS BLUE SHIELD
TXP01258276OtherMEDICARE RR
TX1528224144OtherBLUE CROSS BLUE SHIELD
616771110OtherUS DEPT OF LABOR
TX8DY913OtherBLUE CROSS BLUE SHIELD
TX214907202Medicaid
TX1528224144OtherBLUE CROSS BLUE SHIELD
616771105OtherUS DEPT OF LABOR