Provider Demographics
NPI:1275972564
Name:EDUARDO J SEQUEIRA MD PA
Entity Type:Organization
Organization Name:EDUARDO J SEQUEIRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEQUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-889-7927
Mailing Address - Street 1:79 SATINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1601
Mailing Address - Country:US
Mailing Address - Phone:561-889-7927
Mailing Address - Fax:561-345-3583
Practice Address - Street 1:79 SATINWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1601
Practice Address - Country:US
Practice Address - Phone:561-889-7927
Practice Address - Fax:561-345-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004497000Medicaid