Individual
JACK SEEBURGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
(909) 777-3225
Mailing address
206 ORCHID CT, REDLANDS, CA 92373-6130
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
G083506
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01319854
—
CO
Enumeration date
08/14/2006
Last updated
07/09/2007
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