Provider Demographics
NPI:1275540700
Name:SEABOLT, PHILIP BRIAN (PAC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:BRIAN
Last Name:SEABOLT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 CRENSHAW RD
Mailing Address - Street 2:STE 130
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4615
Mailing Address - Country:US
Mailing Address - Phone:281-991-2200
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:6807 EMMETT F LOWRY EXPRESSWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-945-5444
Practice Address - Fax:409-945-4133
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8E0092Medicare ID - Type Unspecified