Healthcare Provider Details

I. General information

NPI: 1194717363
Provider Name (Legal Business Name): DONALD PAUL SEAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 750
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR STE 750
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-987-3033
  • Fax: 601-987-8768
Mailing address:
  • Phone: 601-987-3033
  • Fax: 601-987-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number14863
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: