Provider Demographics
NPI:1760593172
Name:SEYMOUR, DONALD W (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 PRESTWICK CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5841
Mailing Address - Country:US
Mailing Address - Phone:415-382-8625
Mailing Address - Fax:415-922-6344
Practice Address - Street 1:1 DANIEL BURNHAM CT
Practice Address - Street 2:SUITE 365C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5455
Practice Address - Country:US
Practice Address - Phone:415-202-1920
Practice Address - Fax:415-922-6344
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG8859173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG8859OtherCA LICENSE
CA002120OtherQME CERTIFIICATE
CA002120OtherQME CERTIFIICATE