Provider Demographics
NPI:1891924668
Name:MARVIL, SEAN COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:COLLINS
Last Name:MARVIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1219 GUSDORF RD STE A
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6499
Mailing Address - Country:US
Mailing Address - Phone:703-635-9387
Mailing Address - Fax:575-758-8656
Practice Address - Street 1:1219 GUSDORF RD STE A
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6499
Practice Address - Country:US
Practice Address - Phone:703-635-9387
Practice Address - Fax:575-758-8656
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery