Provider Demographics
NPI:1740492776
Name:SEETS, GARY WAYNE
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:SEETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 W SAINT HELENS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5349
Mailing Address - Country:US
Mailing Address - Phone:318-775-0575
Mailing Address - Fax:318-775-0576
Practice Address - Street 1:8825 W SAINT HELENS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5349
Practice Address - Country:US
Practice Address - Phone:318-775-0575
Practice Address - Fax:318-775-0576
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)