Provider Demographics
NPI:1154315984
Name:STONEBURNER, SEABURY DENNISON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:SEABURY
Middle Name:DENNISON
Last Name:STONEBURNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
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
Practice Address - Country:US
Practice Address - Phone:904-389-9681
Practice Address - Fax:904-389-7975
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME28584207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058252200Medicaid
FL058252200Medicaid
D52540Medicare UPIN