Provider Demographics
NPI:1265493829
Name:BLACKWELL, SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:BLACKWELL
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 1:6410 FANNIN, SUITE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-325-7133
Mailing Address - Fax:713-383-1479
Practice Address - Street 1:6410 FANNIN, SUITE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-325-7133
Practice Address - Fax:713-383-1479
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062286207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187185701Medicaid
TX8F9681OtherBCBSTX
TX187185701Medicaid