MEDICARE: ALFRED SELLERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	4245A	WY

General Provider Information

NPI Number	:	1194172551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED SELLERS M.D.

Provider Business Mailing Address
First Line	:	1105 GARLOCK LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3117
Country	:	US
Telephone Number	:	719-599-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 GARLOCK LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3117
Country	:	US
Telephone Number	:	719-599-8834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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