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1346304540

NPI Code Detail

MEDICARE: SETH B FORMAN MD

MEDICARE: SETH B FORMAN 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	207ND0900X	Dermatopathology Physician	ME96509	FL
2	207NS0135X	Procedural Dermatology Physician	ME96509	FL
3	207N00000X	Dermatology Physician	ME96509	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0013507	OTHER	FL	CIGNA
2	7110910	OTHER	FL	AETNA
3	592235385	OTHER	FL	UNITED HC
4	93048	OTHER	FL	FL BLUE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	592235385	OTHER	FL	MULTIPLAN

General Provider Information

NPI Number	:	1346304540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH B FORMAN MD

Provider Business Mailing Address
First Line	:	15416 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1244
Country	:	US
Telephone Number	:	813-960-4200
Fax Number	:	813-960-2410

Provider Business Practice Location Address
First Line	:	4915 EHRLICH RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2038
Country	:	US
Telephone Number	:	813-960-2400
Fax Number	:

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	09/12/2019

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Directions to “ SETH B FORMAN MD” Practice Location

Language	Start Address	Practice Location

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