Provider Demographics
NPI:1912156290
Name:RICHARD B SEELY MD PA
Entity Type:Organization
Organization Name:RICHARD B SEELY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-306-0722
Mailing Address - Street 1:1835 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3648
Mailing Address - Country:US
Mailing Address - Phone:954-306-0722
Mailing Address - Fax:954-306-0721
Practice Address - Street 1:1835 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3648
Practice Address - Country:US
Practice Address - Phone:954-306-0722
Practice Address - Fax:954-306-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40965ZMedicaid
FLD63702Medicare UPIN