Provider Demographics
NPI:1962598144
Name:SEEFELDT, STEVEN G (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:SEEFELDT
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 1:801 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4045
Mailing Address - Country:US
Mailing Address - Phone:432-580-3700
Mailing Address - Fax:
Practice Address - Street 1:801 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4045
Practice Address - Country:US
Practice Address - Phone:432-580-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6302207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037055301Medicaid
TX037055305Medicaid
TX037055302Medicaid
TX88412HMedicare PIN
TX037055302Medicaid
TX037055305Medicaid