Provider Demographics
NPI:1255420006
Name:SEALE, DAVID RANDAL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDAL
Last Name:SEALE
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 1:8870 CEDAR SPRINGS LANE
Mailing Address - Street 2:STE 209
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-690-4050
Mailing Address - Fax:865-690-0720
Practice Address - Street 1:8870 CEDAR SPRINGS LANE
Practice Address - Street 2:STE 209
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-690-4050
Practice Address - Fax:865-690-0720
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN315182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3853991Medicaid
F74973Medicare UPIN
TN3853991Medicaid