MEDICARE: JACK D. SEIDEL, M.D., P.A.

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	208000000X	Pediatrics Physician	H3940	TX

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	:	1679518245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK D. SEIDEL, M.D., P.A.

Provider Business Mailing Address
First Line	:	4100 ALPHA RD STE 650
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4381
Country	:	US
Telephone Number	:	972-243-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 ALPHA RD STE 650
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4381
Country	:	US
Telephone Number	:	972-243-5437
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACK SEIDEL
Credential	:	M.D.
Telephone Number	:	972-243-5437

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/14/2021

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