Provider Demographics
NPI:1659317584
Name:SEALE, FRED C (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:C
Last Name:SEALE
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 1:3455 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6028
Mailing Address - Country:US
Mailing Address - Phone:303-467-1400
Mailing Address - Fax:303-467-1467
Practice Address - Street 1:3455 LUTHERAN PKWY
Practice Address - Street 2:SUITE 290
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6028
Practice Address - Country:US
Practice Address - Phone:303-467-1400
Practice Address - Fax:303-467-1467
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSE655222OtherANTHEM BCBS OF CO
CO74676750Medicaid
COSE655222OtherANTHEM BCBS OF CO
CO74676750Medicaid
020053816Medicare PIN