Healthcare Provider Details

I. General information

NPI: 1154315984
Provider Name (Legal Business Name): SEABURY DENNISON STONEBURNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY SUITE 658
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

3 SHIRCLIFF WAY SUITE 658
JACKSONVILLE FL
32204
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-9681
  • Fax: 904-389-7975
Mailing address:
  • Phone: 904-389-9681
  • Fax: 904-389-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME28584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: