Provider Demographics
NPI:1164486262
Name:HERON, SEAN P (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:HERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:
Practice Address - Street 1:5747 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1925
Practice Address - Country:US
Practice Address - Phone:727-381-8667
Practice Address - Fax:727-345-1951
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68349208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700823OtherAETNA HMO
938007OtherFIRST HEALTH
FL379031200Medicaid
8207862OtherAETNA PPO
2990017001OtherCIGNA
27138OtherBCBS OF FLORIDA
591226600OtherUNITED HEALTHCARE
27138Medicare ID - Type Unspecified
210047OtherAVMED