Provider Demographics
NPI:1164560702
Name:SEOANE, SERGIO B (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:B
Last Name:SEOANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2717
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33806-2717
Mailing Address - Country:US
Mailing Address - Phone:863-370-0615
Mailing Address - Fax:863-904-2510
Practice Address - Street 1:118 ALLAMANDA DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2926
Practice Address - Country:US
Practice Address - Phone:863-644-2204
Practice Address - Fax:863-904-2510
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 78570207R00000X, 207RC0200X, 207RP1001X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49115Medicare PIN
FLH03254Medicare UPIN