Provider Demographics
NPI:1639274087
Name:SEIDMON, EDWARD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:SEIDMON
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 1:6040 N DESERT SUN CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0925
Mailing Address - Country:US
Mailing Address - Phone:520-908-6038
Mailing Address - Fax:
Practice Address - Street 1:6040 N DESERT SUN CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-0925
Practice Address - Country:US
Practice Address - Phone:520-908-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47566208800000X
MS20355208800000X
AZ36460208800000X
NY134016208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02207509Medicaid
WI34631600Medicaid
MN216122200Medicaid
MN786566OtherFAIRVIEW
MNHP50276OtherHEALTH PARTNERS
MT0151198Medicaid
MN1043324OtherPREFERRED ONE
MN132719OtherUCARE
MN19-00624OtherMEDICA CHOICE
MN2344467OtherARAZ
MSP00735225OtherRAILROAD MEDICARE
MN19-00018OtherMEDICA PRIMARY
MS302I345654Medicare PIN
MN1043324OtherPREFERRED ONE
MN216122200Medicaid