Healthcare Provider Details

I. General information

NPI: 1841480217
Provider Name (Legal Business Name): SEAN G MAYFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOUMA BLVD SUITE 540
METAIRIE LA
70006-2933
US

IV. Provider business mailing address

4224 HOUMA BLVD SUITE 540
METAIRIE LA
70006-2933
US

V. Phone/Fax

Practice location:
  • Phone: 504-456-1410
  • Fax:
Mailing address:
  • Phone: 504-456-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number025989
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number025989
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: