Provider Demographics
NPI:1821519687
Name:FOOTE, SETH CLAYTON (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:CLAYTON
Last Name:FOOTE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36 DUERR DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1401
Mailing Address - Country:US
Mailing Address - Phone:937-573-6682
Mailing Address - Fax:
Practice Address - Street 1:1130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2819
Practice Address - Country:US
Practice Address - Phone:937-208-6879
Practice Address - Fax:937-208-6886
Is Sole Proprietor?:No
Enumeration Date:2017-07-02
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005173RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant