Provider Demographics
NPI:1710178595
Name:DEGOLYER, SEIJI JIM (CRT)
Entity Type:Individual
Prefix:MR
First Name:SEIJI
Middle Name:JIM
Last Name:DEGOLYER
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-2942
Mailing Address - Country:US
Mailing Address - Phone:501-327-6317
Mailing Address - Fax:
Practice Address - Street 1:1820 DRURY LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-2942
Practice Address - Country:US
Practice Address - Phone:501-327-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0785227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified