Healthcare Provider Details

I. General information

NPI: 1972966851
Provider Name (Legal Business Name): SEAN BHAGAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACEHEALTH MEDICAL GROUP 3100 TONGASS AVE
KETCHIKAN AK
99901
US

IV. Provider business mailing address

13001 E 17TH PL UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 907-228-8140
  • Fax: 907-228-8440
Mailing address:
  • Phone: 720-777-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number147438
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: