Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD062446L | PA |
N | 2080P0208X | Pediatric Infectious Diseases | MD062446L | PA |
Y | 2080P0208X | Pediatric Infectious Diseases | P8536 | TX |
NPI | 1376559484 |
---|---|
Provider Name | Michael Evan Sebert |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 02/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001914215 | (05) | PA |
8953201 | (05) | NJ |
H73300 | (02) |