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General NPI Number Information
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NPI Number | 1679518245
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Entity Type | Organization
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Legal Business Name | JACK D. SEIDEL, M.D., P.A.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 4100 ALPHA RD STE 650
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City | FARMERS BRANCH
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State | TX
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Zip | 75244-4381
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Country | US
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Telephone | 972-243-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 ALPHA RD STE 650
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City | FARMERS BRANCH
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State | TX
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Zip | 75244-4381
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Country | US
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Telephone | 972-243-5437
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK SEIDEL
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Credential | M.D.
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Telephone | 972-243-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H3940
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License Number State | TX
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