Healthcare Provider Details

I. General information

NPI: 1467751602
Provider Name (Legal Business Name): SEAN R MCBREARTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8367 MORPHY AVE STE B
FAIRHOPE AL
36532-3653
US

IV. Provider business mailing address

8367 MORPHY AVE STE B
FAIRHOPE AL
36532-3653
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-6334
  • Fax: 251-410-6466
Mailing address:
  • Phone: 251-410-6334
  • Fax: 251-410-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052116
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35587
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: