Provider Demographics
NPI:1578509527
Name:SEIDL, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SEIDL
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-781-7110
Mailing Address - Fax:417-781-8117
Practice Address - Street 1:1020 MCINTOSH CIR STE 203
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3689
Practice Address - Country:US
Practice Address - Phone:417-781-7110
Practice Address - Fax:417-781-8117
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114653207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100011620OtherRR MEDICARE
MO114173OtherANTHEM
MO209799402Medicaid
KS100315010AMedicaid
OK100176490AMedicaid
MO114173OtherANTHEM
OK100176490AMedicaid