Provider Demographics
NPI:1043336274
Name:SEO, DUCK-GI M (MD)
Entity type:Individual
Prefix:
First Name:DUCK-GI
Middle Name:M
Last Name:SEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 HAMMERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5014
Mailing Address - Country:US
Mailing Address - Phone:713-461-8022
Mailing Address - Fax:713-461-8023
Practice Address - Street 1:10131 HAMMERLY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5014
Practice Address - Country:US
Practice Address - Phone:713-461-8022
Practice Address - Fax:713-461-8023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092506701Medicaid
TX092506701Medicaid