Provider Demographics
NPI:1760494496
Name:SEBASTIAN, CYRIL T (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:T
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130070
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0070
Mailing Address - Country:US
Mailing Address - Phone:281-719-9681
Mailing Address - Fax:281-791-0059
Practice Address - Street 1:111 VISION PARK BLVD STE 260
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:281-719-9681
Practice Address - Fax:281-791-0059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96604207T00000X
CAA90741207T00000X
TXN6643207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI29269Medicare UPIN
I29269Medicare UPIN
TXI29269Medicare UPIN