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General NPI Number Information
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NPI Number | 1558554063
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Entity Type | Organization
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Legal Business Name | IDA M SEBASTIAN MD PA
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 4526 SAINT ANDREWS DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4426
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Country | US
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Telephone | 561-737-3174
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Fax | 561-737-3174
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Provider Business Mailing Address
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Address Line | 4526 SAINT ANDREWS DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4426
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Country | US
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Telephone | 561-737-3174
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IDA SEBASTIAN
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Credential | MD
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Telephone | 561-737-3174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME28608
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License Number State | FL
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