Healthcare Provider Details

I. General information

NPI: 1275500233
Provider Name (Legal Business Name): JOHN A SEBAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE 100
SAINT CLOUD MN
56303-1258
US

IV. Provider business mailing address

1245 15TH ST N
SAINT CLOUD MN
56303-1802
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-1775
  • Fax: 320-240-3131
Mailing address:
  • Phone: 320-253-5220
  • Fax: 320-203-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36840
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: