Provider Demographics
NPI:1235138751
Name:DOYLE, SEAN CAMERON (DO)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CAMERON
Last Name:DOYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4047
Mailing Address - Country:US
Mailing Address - Phone:801-756-3511
Mailing Address - Fax:801-443-1164
Practice Address - Street 1:830 N 2000 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4047
Practice Address - Country:US
Practice Address - Phone:801-756-3511
Practice Address - Fax:801-443-1164
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014857207Q00000X
UT6167776-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD7287Medicaid
UT1026429OtherDESERET HEALTHCARE TRUST
UT107047817101OtherSELECT HEALTH
UT30595OtherALTIUS
UT87029387384062B003OtherTRICARE
UT870293873SCDOtherEMI HEALTH
UT97137OtherPEHP
UT87029387384062B003OtherTRICARE