MEDICARE: DR. FAY E SEPPALA MD

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	208600000X	Surgery Physician	MD26361	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407840119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAY E SEPPALA MD

Provider Business Mailing Address
First Line	:	1371 N 10TH AVE
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-2037
Country	:	US
Telephone Number	:	503-769-3785
Fax Number	:	503-769-3741

Provider Business Practice Location Address
First Line	:	1371 N 10TH AVE
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-2037
Country	:	US
Telephone Number	:	503-769-3785
Fax Number	:	503-769-3741

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	05/05/2011

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