Basic Information
| Provider Information | |||||||||
| NPI: | 1790713220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEEGER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2147 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339022147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393439960 | ||||||||
| FaxNumber: | 2393439977 | ||||||||
| Practice Location | |||||||||
| Address1: | 8380 RIVERWALK PARK BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339198758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393439960 | ||||||||
| FaxNumber: | 2393439977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 50977 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 41377 | IA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 110564900 | 05 | FL | MEDICAID |