Provider Demographics
NPI:1932274230
Name:SEABERG, JOHN J III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:SEABERG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1601 E BROADWAY
Mailing Address - Street 2:STE 260
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8020
Mailing Address - Country:US
Mailing Address - Phone:573-443-5500
Mailing Address - Fax:573-442-1540
Practice Address - Street 1:1601 E BROADWAY
Practice Address - Street 2:STE 260
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8020
Practice Address - Country:US
Practice Address - Phone:573-443-5500
Practice Address - Fax:573-442-1540
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMDR5C69208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO007950OtherBLUE CROSS & BLUE SHIELD
MO180560OtherBLUE CROSS & BLUE SHIELD
MO227685OtherHEALTHLINK
MO000005947Medicare PIN
MO227685OtherHEALTHLINK