Healthcare Provider Details

I. General information

NPI: 1720047939
Provider Name (Legal Business Name): MATJAZ SEBENIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD
POMPANO BEACH FL
33064-3502
US

IV. Provider business mailing address

PO BOX 890
BLUEFIELD WV
24701-0890
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME87882
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME87882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: