1235309246 NPI number — JEREMY S SEBASTIAN M.D.

Table of content: JEREMY S SEBASTIAN M.D. (NPI 1235309246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235309246 NPI number — JEREMY S SEBASTIAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEBASTIAN
Provider First Name:
JEREMY
Provider Middle Name:
S
Provider Name Prefix Text:
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:
1235309246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6210 E HWY 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723-1098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 WEST BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
737-406-7312
Provider Business Practice Location Address Fax Number:
512-406-7312
Provider Enumeration Date:
03/05/2008

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: 207Y00000X , with the licence number:  M8983 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 199215804 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199215801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BL260 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 199215805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199215803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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