Provider Demographics
NPI:1881703643
Name:SEBBY, KENNETH R (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:SEBBY
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 1:100 E MADRONA BEACH LN
Mailing Address - Street 2:POB 621
Mailing Address - City:UNION
Mailing Address - State:WA
Mailing Address - Zip Code:98592
Mailing Address - Country:US
Mailing Address - Phone:360-898-0261
Mailing Address - Fax:360-357-9485
Practice Address - Street 1:100 E MADRONA BEACH LN
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WA
Practice Address - Zip Code:98592-0621
Practice Address - Country:US
Practice Address - Phone:360-898-0261
Practice Address - Fax:360-357-9392
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031767207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116243Medicaid
162846OtherL AND I
WA1116243Medicaid
162846OtherL AND I