Healthcare Provider Details

I. General information

NPI: 1013978055
Provider Name (Legal Business Name): EARNEST EDWARD SEILER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 WEST HIBISCUS BLVD STE A
MELBOURNE FL
32901
US

IV. Provider business mailing address

1696 WEST HIBISCUS BLVD STE A
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-0554
  • Fax: 321-952-0202
Mailing address:
  • Phone: 321-725-0554
  • Fax: 321-952-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME51013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: