Healthcare Provider Details

I. General information

NPI: 1720012156
Provider Name (Legal Business Name): JAMES ESTES SEABOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

1202 E TIERRA BUENA LN
PHOENIX AZ
85022-3227
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-222-2617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number22895
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: