Provider Demographics
NPI:1356721955
Name:CHAMBERLAIN, SEAN MCKINLEY (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MCKINLEY
Last Name:CHAMBERLAIN
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 1:2710 FRANCISCO ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3921
Mailing Address - Country:US
Mailing Address - Phone:281-633-1665
Mailing Address - Fax:512-861-1868
Practice Address - Street 1:2710 FRANCISCO ST UNIT 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3921
Practice Address - Country:US
Practice Address - Phone:281-633-1665
Practice Address - Fax:512-861-1868
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7409207Q00000X
TXBP10054209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388872901Medicaid
TX388872902Medicaid