Provider Demographics
NPI:1588770390
Name:SEIDEN, MARK A (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SEIDEN
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:929 E MONTCLAIR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5068
Mailing Address - Country:US
Mailing Address - Phone:417-883-1881
Mailing Address - Fax:417-883-4844
Practice Address - Street 1:929 E MONTCLAIR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5068
Practice Address - Country:US
Practice Address - Phone:417-883-1881
Practice Address - Fax:417-883-4844
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO2000152651213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U74751Medicare UPIN