Healthcare Provider Details

I. General information

NPI: 1720033459
Provider Name (Legal Business Name): WALTER L SEALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 W CURTISIAN STE 200
BOISE ID
83704
US

IV. Provider business mailing address

6140 W CURTISIAN STE 200
BOISE ID
83704
US

V. Phone/Fax

Practice location:
  • Phone: 208-322-1680
  • Fax: 208-322-1695
Mailing address:
  • Phone: 208-322-1680
  • Fax: 208-322-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG58909
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG58909
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberM5874
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: