Provider Demographics
NPI:1942251293
Name:SEYER, MARIO J (DO)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:J
Last Name:SEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3687
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-2529
Mailing Address - Country:US
Mailing Address - Phone:208-819-2183
Mailing Address - Fax:208-209-6063
Practice Address - Street 1:PO BOX 3687
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83816-2529
Practice Address - Country:US
Practice Address - Phone:208-819-2183
Practice Address - Fax:208-209-6063
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD024406207Q00000X
IDO-1919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226957Medicaid
BS7531418OtherDEA
P00092063OtherRR PIN NUMBER
OR226957Medicaid
BS7531418OtherDEA