Provider Demographics
NPI:1295780351
Name:SEYLER, BRIAN L (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:SEYLER
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 1:1856 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-5303
Mailing Address - Country:US
Mailing Address - Phone:520-836-2514
Mailing Address - Fax:520-836-9326
Practice Address - Street 1:1856 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5303
Practice Address - Country:US
Practice Address - Phone:520-836-2514
Practice Address - Fax:520-836-9326
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2111207Q00000X
AZ4096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2561302Medicaid
OH2561302Medicaid