Individual
JAY RICHARD SEIDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
865 W LAKE DR, MOUNT AIRY, NC 27030-2157
(336) 719-6100
(336) 719-2313
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 719-6100
(336) 719-2313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2010-00404
NC
207Q00000X
Family Medicine Physician
34007261
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962407254
—
VA
05
—
2001246000
—
WV
05
—
2252968
—
OH
05
—
5914840
—
NC
Enumeration date
06/15/2005
Last updated
10/25/2020
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