MEDICARE: DR. JACK DAVID SEIDEL 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	208000000X	Pediatrics Physician	H3940	TX

General Provider Information

NPI Number	:	1962613026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK DAVID SEIDEL M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	06/30/2021

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