Provider Demographics
NPI:1902145071
Name:MANZON, SEYMOUR (MD)
Entity Type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:
Last Name:MANZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 DOLPHIN BLVD S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3810
Mailing Address - Country:US
Mailing Address - Phone:727-381-7153
Mailing Address - Fax:
Practice Address - Street 1:1978 DOLPHIN BLVD S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-3810
Practice Address - Country:US
Practice Address - Phone:727-381-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 31185208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME31185OtherUROLOGY