1285880534 NPI number — SEABURY D STONEBURNER JR MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285880534 NPI number — SEABURY D STONEBURNER JR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEABURY D STONEBURNER JR MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285880534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 SHIRCLIFF WAY
Provider Second Line Business Mailing Address:
SUITE 658
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32204-4757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-389-9681
Provider Business Mailing Address Fax Number:
904-389-7975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 SHIRCLIFF WAY
Provider Second Line Business Practice Location Address:
SUITE 658
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-389-9681
Provider Business Practice Location Address Fax Number:
904-389-7975
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STONEBURNER
Authorized Official First Name:
SEABURY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-389-9681

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 058252200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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