Provider Demographics
NPI:1134661358
Name:SEBASTIAN, FRED GREGORY IV (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:GREGORY
Last Name:SEBASTIAN
Suffix:IV
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3506 21ST ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1212
Mailing Address - Country:US
Mailing Address - Phone:806-725-4805
Mailing Address - Fax:
Practice Address - Street 1:3506 21ST ST
Practice Address - Street 2:SUITE 507
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1212
Practice Address - Country:US
Practice Address - Phone:806-725-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA10903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant