Provider Demographics
NPI:1215167291
Name:PAUL A. SELECKY, M.D.,INC.
Entity type:Organization
Organization Name:PAUL A. SELECKY, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SELECKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-764-5505
Mailing Address - Street 1:7202 BLUESAILS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3517
Mailing Address - Country:US
Mailing Address - Phone:949-794-5505
Mailing Address - Fax:949-764-8027
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:PAUL SELECKY - PULMONARY
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-794-5505
Practice Address - Fax:949-764-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30435207R00000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34259Medicare UPIN