Healthcare Provider Details

I. General information

NPI: 1033169875
Provider Name (Legal Business Name): EDWARD HERMAN SEELIGER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1391
US

IV. Provider business mailing address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1391
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-6377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME39390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: