Basic Information
| Provider Information | |||||||||
| NPI: | 1578696159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SETH B FORMAN MD PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3622 MADACA LN | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336182057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139602400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3622 MADACA LN | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336182057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139602400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | FORMAN | ||||||||
| AuthorizedOfficialFirstName: | SETH | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8139602400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | ME96509 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.