Provider Demographics
NPI:1548268782
Name:OH, SEI C (MD)
Entity type:Individual
Prefix:
First Name:SEI
Middle Name:C
Last Name:OH
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 1:515 S ARCHIE ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-4868
Mailing Address - Country:US
Mailing Address - Phone:409-769-2295
Mailing Address - Fax:409-769-3373
Practice Address - Street 1:515 S ARCHIE ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-4868
Practice Address - Country:US
Practice Address - Phone:409-769-2295
Practice Address - Fax:409-769-3373
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2379208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7402001306OtherCOMMERCIAL
TX112053701Medicaid
TX00EP56OtherBCBS
TX826013799OtherRAILROAD MEDICARE
C20014Medicare UPIN
TX00EP56Medicare ID - Type Unspecified