Provider Demographics
NPI:1639104425
Name:CABRERA, SERGIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:J
Last Name:CABRERA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4100 S FERDON BLVD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:US
Mailing Address - Phone:850-398-8940
Mailing Address - Fax:850-398-8943
Practice Address - Street 1:4100 S FERDON BLVD
Practice Address - Street 2:SUITE A4
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5252
Practice Address - Country:US
Practice Address - Phone:850-398-8940
Practice Address - Fax:850-398-8943
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0069027207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593492937OtherFED TAX IDENTIFICATION
FL254367200Medicaid
FL254367200Medicaid
FLG36198Medicare UPIN