Healthcare Provider Details

I. General information

NPI: 1871911149
Provider Name (Legal Business Name): SEAN DORAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR STE 408
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

17501 E 40 HWY STE 213A
INDEPENDENCE MO
64055-6445
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax:
Mailing address:
  • Phone: 816-478-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2017007162
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: