Healthcare Provider Details

I. General information

NPI: 1750356077
Provider Name (Legal Business Name): JAMES CHARLES SEYMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11531 SOUTH US HIGHWAY 301
BELLEVIEW FL
34420-4429
US

IV. Provider business mailing address

PO BOX 4118
BELLEVIEW FL
34421-4118
US

V. Phone/Fax

Practice location:
  • Phone: 352-307-7678
  • Fax: 352-307-7677
Mailing address:
  • Phone: 352-307-7678
  • Fax: 352-307-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0033036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: