Provider Demographics
NPI:1942511555
Name:SEYMOUR, ERIN L (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 E. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-924-9235
Mailing Address - Fax:480-832-5501
Practice Address - Street 1:3940 E. UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-924-9235
Practice Address - Fax:480-832-5501
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21007363A00000X
AZ5689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant