Provider Demographics
NPI:1033168711
Name:REYHANI, SEAN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:A
Last Name:REYHANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57310
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7310
Mailing Address - Country:US
Mailing Address - Phone:281-554-0111
Mailing Address - Fax:281-332-1787
Practice Address - Street 1:1100 GULF FWY S STE 106
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5148
Practice Address - Country:US
Practice Address - Phone:281-554-0111
Practice Address - Fax:281-332-1787
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1730213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177761703Medicaid
TXP00444841OtherRRMEDICARE
TX8X9580OtherBCBSTX
TX177761702Medicaid
TXV06063Medicare UPIN
TX177761703Medicaid
TX177761702Medicaid