Provider Demographics
NPI:1972706547
Name:SECK, THOMAS ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:SECK
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 1:205 NW RD MIZE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2515
Mailing Address - Country:US
Mailing Address - Phone:816-228-4770
Mailing Address - Fax:
Practice Address - Street 1:205 NW RD MIZE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2515
Practice Address - Country:US
Practice Address - Phone:816-228-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12042208000000X
MO2002028904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics