Provider Demographics
NPI:1831338953
Name:SEIDEL, KEITH WILLIAM (NP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:WILLIAM
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-6231
Mailing Address - Country:US
Mailing Address - Phone:432-290-0116
Mailing Address - Fax:432-336-2256
Practice Address - Street 1:2001 W 5TH ST
Practice Address - Street 2:LOCUM TENON
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-6231
Practice Address - Country:US
Practice Address - Phone:432-290-0116
Practice Address - Fax:432-336-2256
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner