Provider Demographics
NPI:1720261084
Name:FAY E. SEPPALA MD, PC
Entity Type:Organization
Organization Name:FAY E. SEPPALA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-769-3785
Mailing Address - Street 1:1371 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-2037
Mailing Address - Country:US
Mailing Address - Phone:503-769-3785
Mailing Address - Fax:503-769-3741
Practice Address - Street 1:1371 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-2037
Practice Address - Country:US
Practice Address - Phone:503-769-3785
Practice Address - Fax:503-769-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26361208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty