MEDICARE: MR. SEAN M TIERNEY DO

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	207P00000X	Emergency Medicine Physician	OS9271	FL
2	207P00000X	Emergency Medicine Physician	DOS933	HI
3	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	20A10991	CA
4	207P00000X	Emergency Medicine Physician	DO2052	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00E0234574	OTHER	HI	BCBS
2	00F0234572	OTHER	HI	BCBS
3	48800	OTHER	FL	BCBS
4	A023	OTHER	HI	CHAMPUS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	A017	OTHER	HI	TRICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	A008	OTHER	HI	CHAMPUS
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578593232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN M TIERNEY DO

Provider Business Mailing Address
First Line	:	6451 N FEDERAL HWY STE 800
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1409
Country	:	US
Telephone Number	:	866-906-1637
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 N FEDERAL HWY STE 800
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1409
Country	:	US
Telephone Number	:	866-906-1637
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/24/2022

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Directions to “ MR. SEAN M TIERNEY DO” Practice Location

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