Provider Demographics
NPI:1841292752
Name:SEYBOLD, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:SEYBOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2312 N NEVADA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5302
Mailing Address - Country:US
Mailing Address - Phone:719-473-3272
Mailing Address - Fax:719-389-1191
Practice Address - Street 1:2312 N NEVADA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5302
Practice Address - Country:US
Practice Address - Phone:719-473-3272
Practice Address - Fax:719-389-1191
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO211612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01211614Medicaid
COD23893Medicare UPIN