MEDICARE: DR. SEBASTIAN ROOSEVELT ALSTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician	ME 102905	FL

General Provider Information

NPI Number	:	1578851812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEBASTIAN ROOSEVELT ALSTON M.D.

Provider Business Mailing Address
First Line	:	1115 W. CALL STREET
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32306-4300
Country	:	US
Telephone Number	:	850-645-2908
Fax Number	:	850-645-2919

Provider Business Practice Location Address
First Line	:	1115 W CALL ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-3556
Country	:	US
Telephone Number	:	850-645-2908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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