Healthcare Provider Details

I. General information

NPI: 1265500946
Provider Name (Legal Business Name): SEITZ DERMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 SEYMOUR AVE
CHEYENNE WY
82001-3830
US

IV. Provider business mailing address

2112 SEYMOUR AVE
CHEYENNE WY
82001-3830
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-8299
  • Fax: 307-635-6984
Mailing address:
  • Phone: 307-635-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number85282A
License Number StateWY

VIII. Authorized Official

Name: DR. GREGORY W SEITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 307-635-8299