=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962599779
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN RAY SEEFELDT DPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1723 W 6TH AV
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-372-3331
-----------------------------------------------------
Fax | 405-372-3547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2321 S LEGENDARY LN
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-377-4257
-----------------------------------------------------
Fax | 405-372-3547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8260
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------