Provider Demographics
NPI:1992744486
Name:SEYMOUR, GARY (NP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5483 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4608
Mailing Address - Country:US
Mailing Address - Phone:903-372-1033
Mailing Address - Fax:
Practice Address - Street 1:2524 N BROADWAY STE 314
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4172
Practice Address - Country:US
Practice Address - Phone:405-256-3261
Practice Address - Fax:801-806-5401
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX548476363L00000X
OK59673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS66118Medicare UPIN