Healthcare Provider Details

I. General information

NPI: 1265692578
Provider Name (Legal Business Name): SEAN MICHAEL SAYRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE MERCY PROFESSIONAL PRACTICE ASSOCIATES
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE.
DES MOINES IA
50314-2610
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-4445
  • Fax: 515-643-8933
Mailing address:
  • Phone: 515-247-4445
  • Fax: 515-643-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39632
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: