Provider Demographics
NPI:1982638102
Name:SEGER, CLINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:
Last Name:SEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SHERIDAN AVE.
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414
Mailing Address - Country:US
Mailing Address - Phone:307-578-2480
Mailing Address - Fax:307-578-2492
Practice Address - Street 1:707 SHERIDAN AVE.
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-2480
Practice Address - Fax:307-578-2492
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010989207Q00000X
WY7929A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664437Medicaid
VT1011747Medicaid
NY02664437Medicaid
VT1011747Medicaid