MEDICARE: DR. SEAN M JONES-QUAIDOO 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	44065	KY
2	390200000X	Student in an Organized Health Care Education/Training Program	0116017695	VA
3	207XS0117X	Orthopaedic Surgery of the Spine Physician	P3361	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K030630	OTHER	KY	MEDICARE PTAN -- NORTON LEATHERMAN SPINE
6	352428ZGRC	OTHER	TX	MEDICARE GROUP, MEMBER PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	50034085	OTHER	KY	PASSPORT HEALTH- NORTON LEATHERMAN SPINE
3	000000720951	OTHER	KY	ANTHEM- NORTON LEATHERMAN SPINE
4	000057120T	OTHER	KY	HUMANA- NORTON LEATHERMAN SPINE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	126874	OTHER	KY	SIHO- NORTON LEATHERMAN SPINE
9	9447007	OTHER	KY	CIGNA -- NLSC

General Provider Information

NPI Number	:	1548473713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN M JONES-QUAIDOO MD

Provider Business Mailing Address
First Line	:	8440 WALNUT HILL LN STE 230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3833
Country	:	US
Telephone Number	:	214-452-7705
Fax Number	:	214-377-8831

Provider Business Practice Location Address
First Line	:	8440 WALNUT HILL LN STE 230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3816
Country	:	US
Telephone Number	:	214-452-7705
Fax Number	:	214-377-8831

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	04/18/2023

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