Provider Demographics
NPI:1487751343
Name:SEUFERT, KEVIN T (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:SEUFERT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:STE 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-692-4401
Mailing Address - Fax:619-692-8147
Practice Address - Street 1:362 W. MISSION AVE
Practice Address - Street 2:STE 105
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-741-1224
Practice Address - Fax:760-741-7010
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG83695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI62329Medicare UPIN
CACB221774Medicare PIN
CAI62329Medicare UPIN
CAW14833Medicare PIN