Provider Demographics
NPI:1790010734
Name:TAS, SEBASTIAN (DO)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:TAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEASE DR STE 401B
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6606
Mailing Address - Country:US
Mailing Address - Phone:727-799-2747
Mailing Address - Fax:727-330-2562
Practice Address - Street 1:1840 MEASE DR STE 401B
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6606
Practice Address - Country:US
Practice Address - Phone:727-799-2747
Practice Address - Fax:727-330-2562
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS10802OtherFLORIDA LICENSE
FL1790010734OtherNPI
FLI06143OtherUPIN
FL010302500Medicaid