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Individual

DEREK KEVIN SEAQUIST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2222 N NEVADA AVE, COLORADO SPRINGS, CO 80907-6819
(719) 776-5816
Mailing address
PO BOX 744127, DALLAS, TX 75374-4127
(719) 776-5816

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0056992
CO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
22764
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9000146429
CO
Enumeration date
04/20/2006
Last updated
02/22/2018
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