Healthcare Provider Details

I. General information

NPI: 1154890879
Provider Name (Legal Business Name): STEPHEN SEITZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SE 24TH ST
GAINESVILLE FL
32641-7516
US

IV. Provider business mailing address

3510 SW 30TH WAY APT 154
GAINESVILLE FL
32608-2774
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: