Provider Demographics
NPI:1134295009
Name:GRAVELY, SEAN ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ERIC
Last Name:GRAVELY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 112A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8252
Mailing Address - Country:US
Mailing Address - Phone:314-251-6339
Mailing Address - Fax:314-251-4564
Practice Address - Street 1:MERCY CLINIC ADULT HOSPITALIST
Practice Address - Street 2:621 S NEW BALLAS RD STE 112A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8252
Practice Address - Country:US
Practice Address - Phone:314-251-6339
Practice Address - Fax:314-251-4564
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013452207R00000X
MO2007011036208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS013452OtherSTATE LICENSE
PAOS013452OtherSTATE LICENSE