Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 40244-020 | WI |
N | 207QA0505X | Family Doctor - Adult Medicine | 40244-020 | WI |
NPI | 1194827113 |
---|---|
Provider Name | Dr. Ricky Lee Seabul |
First Address | Parker, AZ 85344-7718 |
Second Address | Parker, AZ 85344-7718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 28/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34048300 | (05) | WI |
H30357 | (02) | |
H30357 | (02) | SD |