Provider Demographics
NPI:1467751602
Name:MCBREARTY, SEAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:R
Last Name:MCBREARTY
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 1:8367 MORPHY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3653
Mailing Address - Country:US
Mailing Address - Phone:251-410-6334
Mailing Address - Fax:251-410-6466
Practice Address - Street 1:8367 MORPHY AVE STE B
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3653
Practice Address - Country:US
Practice Address - Phone:251-410-6334
Practice Address - Fax:251-410-6466
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO052116207Q00000X
390200000X
AL35587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12050580Medicaid
CO024420OtherKAISER COMMERCIAL NUMBER
CO12050580Medicaid