Provider Demographics
NPI:1578593232
Name:TIERNEY, SEAN M (DO)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:TIERNEY
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 1:6451 N FEDERAL HWY STE 800
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1409
Mailing Address - Country:US
Mailing Address - Phone:866-906-1637
Mailing Address - Fax:
Practice Address - Street 1:6451 N FEDERAL HWY STE 800
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1409
Practice Address - Country:US
Practice Address - Phone:866-906-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9271207P00000X
HIDOS933207P00000X
CA20A10991207PE0004X
NVDO2052207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00E0234574OtherBCBS
HI00F0234572OtherBCBS
FL48800OtherBCBS
HIA023OtherCHAMPUS
HI50772512Medicaid
HI50772513Medicaid
HIA017OtherTRICARE
HI50772509Medicaid
FL000178500Medicaid
HIA008OtherCHAMPUS
HI50772510Medicaid
HIA017OtherTRICARE
HI00F0234572OtherBCBS
HI101305Medicare ID - Type Unspecified
HI50772510Medicaid