Healthcare Provider Details

I. General information

NPI: 1336158005
Provider Name (Legal Business Name): STEPHEN J SEFFENSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ROGERS AVE
FORT SMITH AR
72903-4073
US

IV. Provider business mailing address

PO BOX 3528
FORT SMITH AR
72913-3528
US

V. Phone/Fax

Practice location:
  • Phone: 479-274-5100
  • Fax: 479-274-5179
Mailing address:
  • Phone: 479-274-2000
  • Fax: 479-274-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-0613
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: