Healthcare Provider Details

I. General information

NPI: 1831290154
Provider Name (Legal Business Name): SETH AMMERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

IV. Provider business mailing address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-5494
  • Fax: 707-385-2157
Mailing address:
  • Phone: 707-433-5494
  • Fax: 707-385-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG54409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: