MEDICARE: CONRAD THEODORE SEITZ M.D

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	207Q00000X	Family Medicine Physician	G56476	CA

General Provider Information

NPI Number	:	1093820748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONRAD THEODORE SEITZ M.D

Provider Business Mailing Address
First Line	:	2570 JENSEN AVE
Second Line	:	SUITE 106
City	:	SANGER
State	:	CA
Zip	:	96357
Country	:	US
Telephone Number	:	559-875-3428
Fax Number	:	559-875-3434

Provider Business Practice Location Address
First Line	:	2570 JENSEN AVE
Second Line	:	SUITE 106
City	:	SANGER
State	:	CA
Zip	:	93657-2269
Country	:	US
Telephone Number	:	559-875-3428
Fax Number	:	559-875-3434

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/08/2008

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