Provider Demographics
NPI:1972550416
Name:KUYPER, SEAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:JOSEPH
Last Name:KUYPER
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 1:7860 GATE PKWY
Mailing Address - Street 2:SUITE 123
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7279
Mailing Address - Country:US
Mailing Address - Phone:904-996-8100
Mailing Address - Fax:904-996-8101
Practice Address - Street 1:7860 GATE PKWY
Practice Address - Street 2:SUITE 123
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7279
Practice Address - Country:US
Practice Address - Phone:904-996-8100
Practice Address - Fax:904-996-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME840032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6499ZMedicare ID - Type Unspecified
FLH51492Medicare UPIN