1649277492 NPI number — DR. MARK V SEBY M.D.

Table of content: DR. MARK V SEBY M.D. (NPI 1649277492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649277492 NPI number — DR. MARK V SEBY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEBY
Provider First Name:
MARK
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649277492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 N AGASSIZ ST
Provider Second Line Business Mailing Address:
BLDG 1
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-779-6169
Provider Business Mailing Address Fax Number:
928-779-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 N AGASSIZ ST
Provider Second Line Business Practice Location Address:
BLDG 1
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-779-6169
Provider Business Practice Location Address Fax Number:
928-779-4200
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ZA11476 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 23957601 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1Z8845 . This is a "HEALTH NET AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5447372 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z63389 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1003440 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 71412 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 080008588 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0021730 . This is a "BCBS AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com