Basic Information
Provider Information
NPI: 1235169194
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEITZ
FirstName: DAVID
MiddleName: JOSEPH
NamePrefix:  
NameSuffix: IV
Credential: P.A.-C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7643
Address2:  
City: LOVELAND
State: CO
PostalCode: 805370643
CountryCode: US
TelephoneNumber: 9706632742
FaxNumber: 9703422093
Practice Location
Address1: 1708 BOISE AVE
Address2:  
City: LOVELAND
State: CO
PostalCode: 805384204
CountryCode: US
TelephoneNumber: 9706673116
FaxNumber: 9706690159
Other Information
ProviderEnumerationDate: 07/04/2006
LastUpdateDate: 11/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA1762COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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