Healthcare Provider Details

I. General information

NPI: 1568559029
Provider Name (Legal Business Name): ROBIN D SEBASTIAN M.D., FAAFP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E LOCUST ST
EMMETT ID
83617-2713
US

IV. Provider business mailing address

1102 E LOCUST ST
EMMETT ID
83617-2713
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-6004
  • Fax: 208-365-3589
Mailing address:
  • Phone: 208-365-6004
  • Fax: 208-365-3589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD435743
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT188205
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM10681
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: