Provider Demographics
NPI:1619914751
Name:SEEGMILLER, DAVID C (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:SEEGMILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540610
Mailing Address - Street 2:
Mailing Address - City:N SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0610
Mailing Address - Country:US
Mailing Address - Phone:801-451-6060
Mailing Address - Fax:801-296-0218
Practice Address - Street 1:82 S 1100 E
Practice Address - Street 2:SUITE 301
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1686
Practice Address - Country:US
Practice Address - Phone:801-505-5277
Practice Address - Fax:801-505-5280
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT993709470501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT53685OtherPEHP
UT633199OtherDMBA
UT107008733OtherIHC (SELECT HEALTH)
UT870637613Medicare UPIN
UT000012152Medicare ID - Type Unspecified
UT5199710001Medicare NSC