Individual
SEI C OH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 S ARCHIE ST, VIDOR, TX 77662-4868
(409) 769-2295
(409) 769-3373
Mailing address
515 S ARCHIE ST, VIDOR, TX 77662-4868
(409) 769-2295
(409) 769-3373
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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