Healthcare Provider Details

I. General information

NPI: 1780329987
Provider Name (Legal Business Name): SEAN TRUEMAN WICKERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

9123 E MISSISSIPPI AVE APT 15-303
DENVER CO
80247-6882
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA191649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: