Provider Demographics
NPI:1740485739
Name:SEYMOUR, JEROME EVERETT (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:EVERETT
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7603 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9384
Mailing Address - Country:US
Mailing Address - Phone:231-547-5490
Mailing Address - Fax:231-547-5490
Practice Address - Street 1:7603 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9384
Practice Address - Country:US
Practice Address - Phone:231-547-5490
Practice Address - Fax:231-547-5490
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301028156208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology