Provider Demographics
NPI:1811924327
Name:SEIDEL, AUDREY M (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:M
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:SOCORRO GENERAL HOSPITAL
Mailing Address - Street 2:1202 HIGHWAY 60 WEST
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801
Mailing Address - Country:US
Mailing Address - Phone:575-838-4690
Mailing Address - Fax:575-838-8859
Practice Address - Street 1:SOCORRO GENERAL HOSPITAL
Practice Address - Street 2:1202 HIGHWAY 60 WEST
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801
Practice Address - Country:US
Practice Address - Phone:575-838-4690
Practice Address - Fax:575-838-8859
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0727207V00000X
MDD0055448207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology