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Individual

JACK L. SEAQUIST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1301 W. 38TH ST. #102, AUSTIN, TX 78705-1010
(512) 454-4561
(512) 467-2906
Mailing address
PO BOX 26726, AUSTIN, TX 78755-0726
(512) 407-8686
(512) 421-4489

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D9654
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
094771502
TX
05
117193604
TX
01
4048662
AETNA TRS
TX
01
817420
SCOTT & WHITE
TX
Enumeration date
07/03/2006
Last updated
10/13/2010
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