Provider Demographics
NPI:1285880534
Name:SEABURY D STONEBURNER JR MD PA
Entity type:Organization
Organization Name:SEABURY D STONEBURNER JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEABURY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STONEBURNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-389-9681
Mailing Address - Street 1:3 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 658
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4757
Mailing Address - Country:US
Mailing Address - Phone:904-389-9681
Mailing Address - Fax:904-389-7975
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 658
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4757
Practice Address - Country:US
Practice Address - Phone:904-389-9681
Practice Address - Fax:904-389-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058252200Medicaid
FLD52540Medicare UPIN
FL15363Medicare PIN