Provider Demographics
NPI:1245394543
Name:SEBERG, GEORGE HERBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HERBERT
Last Name:SEBERG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2324 NUUANU AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1714
Mailing Address - Country:US
Mailing Address - Phone:808-536-3222
Mailing Address - Fax:808-545-3099
Practice Address - Street 1:850 W HIND DR
Practice Address - Street 2:STE 109
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-373-5728
Practice Address - Fax:808-377-3432
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI045209Medicaid
HIM5141-9OtherHMSA
HIH0000BDNDSMedicare ID - Type Unspecified
HI045209Medicaid