Provider Demographics
NPI:1639171929
Name:SEALS, JOHN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:SEALS
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 1:4410 MEDICAL DR
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3855
Mailing Address - Country:US
Mailing Address - Phone:210-615-2255
Mailing Address - Fax:210-615-8120
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:STE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3855
Practice Address - Country:US
Practice Address - Phone:210-615-2255
Practice Address - Fax:210-615-8120
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD33952084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB88233Medicare UPIN
TX00HH57Medicare ID - Type Unspecified
TX00HH57Medicare PIN