MEDICARE: DR. SEAN PATRICK O' ROURKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME90257	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255303947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN PATRICK O' ROURKE MD

Provider Business Mailing Address
First Line	:	1527 EAGLE RIDGE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-5680
Country	:	US
Telephone Number	:	863-680-7000
Fax Number	:	863-680-7420

Provider Business Practice Location Address
First Line	:	1527 EAGLE RIDGE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-5680
Country	:	US
Telephone Number	:	863-680-7000
Fax Number	:	866-264-8519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/30/2020

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