Healthcare Provider Details

I. General information

NPI: 1598741555
Provider Name (Legal Business Name): LARRY E SEITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 08/13/2012
Certification Date:
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: 307-635-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2623A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: