Individual
DR. ROBIN D SEBASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., FAAFP
Contact information
Practice address
1102 E LOCUST ST, EMMETT, ID 83617-2713
(208) 365-6004
(208) 365-3589
Mailing address
1102 E LOCUST ST, EMMETT, ID 83617-2713
(208) 365-6004
(208) 365-3589
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M10681
ID
207Q00000X
Family Medicine Physician
MD435743
PA
207Q00000X
Family Medicine Physician
MT188205
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010174773
REGENCE BLUE SHIELD OF IDAHO
ID
05
—
808440300
—
ID
05
—
808440301
—
ID
05
—
808440302
—
ID
01
—
M10681
IDAHO LICENSE NUMBER
ID
01
—
MD125789
OREGON LICENSE NUMBER
OR
Enumeration date
10/06/2006
Last updated
07/29/2024
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