MEDICARE: PAYTON FURMAN SELLERS 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME133420	FL
2	208D00000X	General Practice Physician	ME133420	FL
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1154700888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYTON FURMAN SELLERS M.D.

Provider Business Mailing Address
First Line	:	6253 14TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4611
Country	:	US
Telephone Number	:	941-753-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	6253 14TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4611
Country	:	US
Telephone Number	:	941-753-0877
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/29/2019

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