Provider Demographics
NPI:1730144023
Name:HERBST, SETH JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:JORDAN
Last Name:HERBST
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 1:1395 S STATE ROAD 7
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9325
Mailing Address - Country:US
Mailing Address - Phone:561-798-1233
Mailing Address - Fax:561-798-1655
Practice Address - Street 1:1395 S STATE ROAD 7
Practice Address - Street 2:SUITE 450
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9325
Practice Address - Country:US
Practice Address - Phone:561-798-1233
Practice Address - Fax:561-798-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53384207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370056900Medicaid
FL370056900Medicaid
FL08873Medicare ID - Type Unspecified