Provider Demographics
NPI:1619493038
Name:SEIFMAN, DOUGLAS W
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:W
Last Name:SEIFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 E STATE ROUTE 69 LOT 254
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-4523
Mailing Address - Country:US
Mailing Address - Phone:928-225-5486
Mailing Address - Fax:
Practice Address - Street 1:PISCADERAWEG
Practice Address - Street 2:
Practice Address - City:WILLEMSTAD
Practice Address - State:CURAAO
Practice Address - Zip Code:04797
Practice Address - Country:AN
Practice Address - Phone:599-946-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ867530921Medicaid