MR. FRED GREGORY SEBASTIAN IV (NPI# 1134661358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134661358 |
| Entity Type | Individual |
| Full Name | MR. FRED GREGORY SEBASTIAN IV |
| Credential | PA-C |
| Practice Address |
3506 21st St Suite 507 Lubbock TX 79410-1212 |
| Practice Telephone | 8067254805 |
| Mailing Telephone | 8067254805 |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA10903 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3506 21ST ST SUITE 507 |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79410-1212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306849419 | Kenneth Edward Kruczek | Internal Medicine | 3506 21st St, Suite 605, Lubbock, TX 79410-1212 | 2005-05-23 |
| 1295284396 | Caitlin Sarah Blair | Nurse Practitioner | 3506 21st St, Ste 607, Lubbock, TX 79410-1212 | 2016-09-29 |
| 1851744957 | Brandy Gilbrett Trevino | Nurse Practitioner | 3506 21st St, Ste. 507, Lubbock, TX 79410-1212 | 2016-07-13 |
| 1366848541 | Gabriella Trevino Davis | Nurse Practitioner | 3506 21st St, Lubbock, TX 79410-1212 | 2014-11-14 |
| 1760817324 | Monica Caraveo Pilip | Nurse Practitioner | 3506 21st St, Suite 203, Lubbock, TX 79410-1212 | 2013-09-13 |
| 1770829012 | Susan Doctolero | Nurse Practitioner | 3506 21st St, Suite 302, Lubbock, TX 79410-1212 | 2012-12-13 |
| 1164798989 | Amy D'ann Gordon | Nurse Practitioner | 3506 21st St, Suite 607, Lubbock, TX 79410-1212 | 2012-03-27 |
| 1164791257 | Sharronda Richawn Bradford | Nurse Practitioner | 3506 21st St, Suite605, Lubbock, TX 79410-1212 | 2011-12-20 |
| 1477821106 | Theophilus O Olumese | Hospitalist | 3506 21st St, Suite 605, Lubbock, TX 79410-1212 | 2011-12-08 |
| 1831484831 | Katie L. Hendley | Psychiatry & Neurology | 3506 21st St, Suite 400, Lubbock, TX 79410-1212 | 2011-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548878267 | Covenant Medical Center | Clinic/Center | 3615 19th, Lifestyle Centre-east Parking Garage, Lubbock, TX 79410 | 2020-07-20 |
| 1669038626 | Hub City Anesthesia | Nurse Anesthetist, Certified Registered | 3416 22nd Street, Lubbock, TX 79410 | 2019-05-15 |
| 1912447418 | Lubbock Surgery Center, LLC | Clinic/Center | 3416 22nd St, Lubbock, TX 79410 | 2017-03-02 |
| 1871032698 | Lezlee Berry | Pharmacist | 3615 19th Street, Lubbock, TX 79410 | 2017-02-13 |
| 1376914101 | Matthew Cotton | Nurse Practitioner | 2424 Quaker Ave, Lubbock, TX 79410 | 2015-10-20 |
| 1841534864 | Frank Nwabugwu | Pharmacist | 4120 34th Street, Lubbock, TX 79410 | 2012-11-15 |
| 1689954794 | Dharmendra Kumar | Pediatrics | Covenant Children's Hospital, 4000 24th Street, Lubbock, TX 79410 | 2011-08-19 |
| 1518277177 | T.r.m. Rao, M.d., P.a. | Colon & Rectal Surgery | 3809 22nd Street, Suite C, Lubbock, TX 79410 | 2010-10-18 |
| 1700196672 | Hanford Consultations P.a. | Family Medicine | 4000 22nd Place Suite 100, Lubbock, TX 79410 | 2010-10-13 |
| 1336452598 | Amanda Collins | Specialist | 4801 34th Street, Lubbock, TX 79410 | 2010-07-16 |
| Find all providers in zip 79410 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316294408 | Ronald Caporale | Physician Assistant | 1701 50th Street, Lubbock, TX 79412 | 2012-08-08 |
| 1699002675 | Jamie Fletcher | Physician Assistant | 5415 114th St, Lubbock, TX 79424 | 2009-11-11 |
| 1710160700 | Jessica Ferguson | Physician Assistant | 3606 21st St Ste 200, Lubbock, TX 79410-1225 | 2007-12-12 |
| 1104958560 | Janice Hallford Lampe | Physician Assistant | 6048 Marsha Sharp Fwy, Lubbock, TX 79407-3726 | 2007-03-12 |
| 1699819953 | Holly Jen Tyson | Physician Assistant | 3811 24th St, Lubbock, TX 79410-1813 | 2007-02-19 |
| 1154496974 | Kathleen Jo Marcum | Physician Assistant | 3801 21st St, Suite 200, Lubbock, TX 79410-1006 | 2006-11-21 |
| 1336252220 | Gustavo Alonso Bendeck | Physician Assistant | 4010 22nd St, Lubbock, TX 79410-1116 | 2006-08-16 |
| 1316903875 | Kristina Lee | Physician Assistant | 3904 101st St, Lubbock, TX 79423-5725 | 2006-04-25 |
| 1467416636 | David Anthony King | Physician Assistant | 3514 21st Street, Lubbock, TX 79410 | 2006-04-14 |
| 1346246634 | Phyllis Rose Peterson | Physician Assistant | Ttuhsc Dept of Psychiatry, 3601 4th St., Ms 8103, Lubbock, TX 79430-8103 | 2005-06-22 |
| Find all providers in LUBBOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.