Provider Demographics
NPI:1871541052
Name:SETH J HERBST MD PA
Entity type:Organization
Organization Name:SETH J HERBST MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-798-1233
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9325
Mailing Address - Country:US
Mailing Address - Phone:561-798-1233
Mailing Address - Fax:561-798-1655
Practice Address - Street 1:1395 S STATE ROAD 7
Practice Address - Street 2:SUITE 450
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9325
Practice Address - Country:US
Practice Address - Phone:561-798-1233
Practice Address - Fax:561-798-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271465500Medicaid
FL271465500Medicaid