MEDICARE: DR. ROBERTO SEIDNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G4397	TX

General Provider Information

NPI Number	:	1063467074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO SEIDNER MD

Provider Business Mailing Address
First Line	:	333 LINKS DR APT 1512
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-8523
Country	:	US
Telephone Number	:	361-510-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LINKS DR APT 1512
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-8523
Country	:	US
Telephone Number	:	361-510-3451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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