Healthcare Provider Details

I. General information

NPI: 1649485616
Provider Name (Legal Business Name): WILLIAM KENT SELTZER PH.D., F.A.C.M.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 3RD AVE APT. 305
SAN MATEO CA
94402-1561
US

IV. Provider business mailing address

111 W 3RD AVE APT. 305
SAN MATEO CA
94402-1561
US

V. Phone/Fax

Practice location:
  • Phone: 508-277-7547
  • Fax:
Mailing address:
  • Phone: 508-277-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberSELTW1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number25MS00007900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number1052CLS
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberDRN00000038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: