MEDICARE: DOUGLAS E. SEGLEM D.O.

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	2080N0001X	Neonatal-Perinatal Medicine Physician	E-5281	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497876460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS E. SEGLEM D.O.

Provider Business Mailing Address
First Line	:	P.O. BOX 11350
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917
Country	:	US
Telephone Number	:	479-314-4635
Fax Number	:	479-314-4634

Provider Business Practice Location Address
First Line	:	7301 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903
Country	:	US
Telephone Number	:	479-314-4635
Fax Number	:	479-314-4634

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	10/14/2010

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Directions to “ DOUGLAS E. SEGLEM D.O.” Practice Location

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