Provider Demographics
NPI:1861786246
Name:SEBESTO, JASON R (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:SEBESTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 MILL RUN CT
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-3122
Mailing Address - Country:US
Mailing Address - Phone:970-205-9995
Mailing Address - Fax:
Practice Address - Street 1:871 MILL RUN CT
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-3122
Practice Address - Country:US
Practice Address - Phone:970-205-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91-3212084N0400X
FLOS119002084N0400X
MI51010244162084N0400X, 2084N0400X
CODR.00573702084N0400X
ORDO1909482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01518758OtherRAILROAD MEDICARE
NH3115953Medicaid
FL014752900Medicaid