Provider Demographics
NPI:1194719518
Name:SEYMOUR, CLINT THURMOND (MD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:THURMOND
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WINDING CREEK CV
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8761
Mailing Address - Country:US
Mailing Address - Phone:864-980-2970
Mailing Address - Fax:501-222-6741
Practice Address - Street 1:7 WINDING CREEK CV
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8761
Practice Address - Country:US
Practice Address - Phone:864-980-2970
Practice Address - Fax:501-222-6741
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT6378207Q00000X
ARE-12736207Q00000X
FL140794261QU0200X
SC23619207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00430617OtherMEDICARE RAILROAD PTAN
H863850281OtherMEDICARE PTAN
SCT78680Medicaid
H863850281OtherMEDICARE PTAN