Provider Demographics
NPI:1255303947
Name:O' ROURKE, SEAN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:O' ROURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:PATRICK
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1527 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5680
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:863-680-7420
Practice Address - Street 1:1527 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-5680
Practice Address - Country:US
Practice Address - Phone:863-680-7000
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90257207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270193600Medicaid
FL0471260001Medicare NSC
FL44031ZMedicare PIN
FL270193600Medicaid