Healthcare Provider Details

I. General information

NPI: 1285880534
Provider Name (Legal Business Name): SEABURY D STONEBURNER JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY SUITE 658
JACKSONVILLE FL
32204-4757
US

IV. Provider business mailing address

3 SHIRCLIFF WAY SUITE 658
JACKSONVILLE FL
32204-4757
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 Number
License Number State

VIII. Authorized Official

Name: DR. SEABURY D STONEBURNER JR.
Title or Position: OWNER
Credential: M.D.
Phone: 904-389-9681