Healthcare Provider Details

I. General information

NPI: 1447618384
Provider Name (Legal Business Name): SEAN BARNETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 09/22/2023
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DRIVE WRIGHT PATTERSON AIR FORCE BASE
DAYTON OH
45433-4543
US

IV. Provider business mailing address

4881 SUGAR MAPLE DRIVE WRIGHT PATTERSON AIR FORCE BASE
DAYTON OH
45433
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-8137
  • Fax:
Mailing address:
  • Phone: 937-257-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0102205053
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102205053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: