Provider Demographics
NPI:1457417438
Name:SEELY, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:SEELY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2645 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE #147
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:954-306-0722
Mailing Address - Fax:954-306-0721
Practice Address - Street 1:2645 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE #147
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:954-306-0722
Practice Address - Fax:954-306-0721
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00374222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042422600Medicaid
FLBCBS96031OtherBCBS IND
FLGROUPBCBS40965OtherBCBS GROUP
960312Medicare ID - Type Unspecified
FLGROUPBCBS40965OtherBCBS GROUP