Provider Demographics
NPI:1730370875
Name:SEALS, SCOTT RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RYAN
Last Name:SEALS
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:3144 HORIZON RD STE 110
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7046
Practice Address - Country:US
Practice Address - Phone:972-771-3322
Practice Address - Fax:972-771-0272
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202248207RH0003X
TXQ1297207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00773785OtherMEDICARE RAILROAD
TXP01867713OtherRAILROAD
MS09189500Medicaid
TX341884003Medicaid
LA1091383Medicaid
TX341884002Medicaid
TX385505YKYCMedicare PIN
MS302I115921Medicare PIN
MS302I117996Medicare PIN
TX341884003Medicaid
TX385505YM09Medicare PIN
LA4N5137061Medicare PIN