Healthcare Provider Details

I. General information

NPI: 1013964311
Provider Name (Legal Business Name): SEAN EDWIN BOURKE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062
US

IV. Provider business mailing address

2100 POWELL STREET STE 920
EMERYVILLE CA
94608-1803
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-5811
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax: 510-879-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA65939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: