Healthcare Provider Details

I. General information

NPI: 1932733086
Provider Name (Legal Business Name): SETH JACOB SELBY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BUCK CREEK RD STE 200
AVON CO
81620-5428
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 301
HIGHLANDS RANCH CO
80129-2277
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-6340
  • Fax: 970-926-6348
Mailing address:
  • Phone: 303-814-0505
  • Fax: 303-814-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0006899
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: