Provider Demographics
NPI:1689731606
Name:DAILAMI-POUR, SEAN SHAHZAD (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:SHAHZAD
Last Name:DAILAMI-POUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAHZAD
Other - Middle Name:
Other - Last Name:DAILAMI-POUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:116 HAYDEN ST
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038
Mailing Address - Country:US
Mailing Address - Phone:601-859-5213
Mailing Address - Fax:601-859-8771
Practice Address - Street 1:116 HAYDEN STREET
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038
Practice Address - Country:US
Practice Address - Phone:662-247-1252
Practice Address - Fax:662-247-3865
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124063Medicaid
MS0124063Medicaid
MS0124063Medicaid