Provider Demographics
NPI:1780784413
Name:SEBERT, GARY M (CRNA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:SEBERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7154 N UNIVERSITY DR
Mailing Address - Street 2:#316
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2916
Mailing Address - Country:US
Mailing Address - Phone:954-720-3188
Mailing Address - Fax:954-722-6996
Practice Address - Street 1:7154 N UNIVERSITY DR # 316
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2916
Practice Address - Country:US
Practice Address - Phone:954-720-3188
Practice Address - Fax:954-722-6996
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9252465367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC254ZMedicare PIN
R73305Medicare UPIN