MEDICARE: RANDELL JAY SEHRES MD

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	207Q00000X	Family Medicine Physician	ME80519	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891724704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDELL JAY SEHRES MD

Provider Business Mailing Address
First Line	:	1046 CYPRESS VILLAGE BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6845
Country	:	US
Telephone Number	:	813-633-0081
Fax Number	:	813-633-0082

Provider Business Practice Location Address
First Line	:	1046 CYPRESS VILLAGE BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6845
Country	:	US
Telephone Number	:	813-633-0081
Fax Number	:	813-633-0082

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	05/07/2024

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