# MARK SEBY MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** AGASSIZ FAMILY MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477726222
- **Authorized official:** MR. MARK VINCENT SEBY M.D. (PHYSICIAN)
- **Authorized official phone:** (928) 779-6169

## Contact information

- **Practice address:** 417 N AGASSIZ ST, BLDG \#1, FLAGSTAFF, AZ 86001-3282
- **Practice address phone:** (928) 779-6169
- **Practice address fax:** (928) 779-4200
- **Mailing address:** 417 N AGASSIZ ST, BLDG \#1, FLAGSTAFF, AZ 86001-3282
- **Mailing address phone:** (928) 779-6169
- **Mailing address fax:** (928) 779-4200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | AZ11476 | AZ | Yes |

## Other

- **Enumeration date:** 04/11/2008
- **Last updated:** 12/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 080008588 | RAILROAD MEDICARE | AZ |
| 01 | — | 188857300 | US DEPT OF LABOR | AZ |
| 01 | — | 1Z8845 | HEALTHNET AZ | AZ |
| 05 | — | 23957601 | — | AZ |
| 01 | — | 3323257 | CIGNA | AZ |
| 01 | — | 5447372 | AETNA | AZ |
| 01 | — | 71412 | MUTUAL OF OMAHA | AZ |
| 01 | — | 87726 | UNITED HEALTHCARE | AZ |
| 01 | — | AZ0021730 | BLUE CROSS BLUE SHIELD AZ | AZ |