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Individual
SEI C OH
Active
Individual
SEI C OH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
F2379
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00EP56
BCBS
TX
05
—
112053701
—
TX
01
—
7402001306
COMMERCIAL
TX
01
—
826013799
RAILROAD MEDICARE
TX
Enumeration date
07/12/2005
Last updated
02/12/2015
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