Provider Demographics
NPI:1629008057
Name:SEYMOUR, EUGENE HOWARD (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:HOWARD
Last Name:SEYMOUR
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 1:390 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1526
Mailing Address - Country:US
Mailing Address - Phone:310-486-5677
Mailing Address - Fax:630-604-6402
Practice Address - Street 1:390 N SPRING ST
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1526
Practice Address - Country:US
Practice Address - Phone:310-486-5677
Practice Address - Fax:630-604-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23659OtherM.D.