Provider Demographics
NPI:1982843967
Name:SEYMOUR, PETER ANDREW (PETER SEYMOUR DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:PETER SEYMOUR DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7613
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119603207XX0005X
IN02003722A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200989810Medicaid
IN000000669885OtherANTHEM PROVIDER NUMBER
IN200989810Medicaid
IN000000669885OtherANTHEM PROVIDER NUMBER