Provider Demographics
NPI:1437447612
Name:SEYMOUR, PAULINE SONG (DPM)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:SONG
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 OAK PARK RD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1361
Mailing Address - Country:US
Mailing Address - Phone:402-658-9681
Mailing Address - Fax:
Practice Address - Street 1:1707 OAK PARK RD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1361
Practice Address - Country:US
Practice Address - Phone:402-658-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073779213ES0103X
NE351213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery