MEDICARE: MR. SETH CLAYTON FOOTE PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	50.005173RX	OH

General Provider Information

NPI Number	:	1821519687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SETH CLAYTON FOOTE PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	36 DUERR DR
Second Line	:
City	:	WEST MILTON
State	:	OH
Zip	:	45383-1401
Country	:	US
Telephone Number	:	937-573-6682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 S MAIN ST
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2819
Country	:	US
Telephone Number	:	937-208-6879
Fax Number	:	937-208-6886

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

Provider Enumeration Date	:	07/02/2017
Last Update Date	:	07/15/2024

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