Individual
SETH B FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4915 EHRLICH RD, TAMPA, FL 33624-2038
(813) 960-2400
Mailing address
15416 N FLORIDA AVE, TAMPA, FL 33613-1244
(813) 960-4200
(813) 960-2410
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME96509
FL
207ND0900X
Dermatopathology Physician
ME96509
FL
207NS0135X
Procedural Dermatology Physician
ME96509
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013507
CIGNA
FL
05
—
010196800
—
FL
01
—
592235385
UNITED HC
FL
01
—
7110910
AETNA
FL
01
—
93048
FL BLUE
FL
Enumeration date
12/21/2006
Last updated
09/12/2019
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